Healthcare Provider Details

I. General information

NPI: 1205714268
Provider Name (Legal Business Name): INNER BALANCE NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 CALAVO DR
LA MESA CA
91941-7052
US

IV. Provider business mailing address

4140 CALAVO DR
LA MESA CA
91941-7052
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-6992
  • Fax: 833-605-4359
Mailing address:
  • Phone: 310-800-1977
  • Fax: 833-605-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VINCENT FEITOSA
Title or Position: OWNER
Credential: PMHNP
Phone: 201-500-6992