Healthcare Provider Details

I. General information

NPI: 1245120229
Provider Name (Legal Business Name): BALANCED DIET PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355
US

IV. Provider business mailing address

27629 YARDLEY WAY
VALENCIA CA
91354-1606
US

V. Phone/Fax

Practice location:
  • Phone: 818-987-5003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SHAHRZAD FOROODI
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 818-987-5003