Healthcare Provider Details

I. General information

NPI: 1952756868
Provider Name (Legal Business Name): ESTATES BALANCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SW 52ND TER
CAPE CORAL FL
33914-7485
US

IV. Provider business mailing address

11725 COLLIER BLVD SUITE H1
NAPLES FL
34116-6524
US

V. Phone/Fax

Practice location:
  • Phone: 239-349-2500
  • Fax: 239-349-2501
Mailing address:
  • Phone: 239-349-2500
  • Fax: 239-349-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME6001
License Number StateFL

VIII. Authorized Official

Name: ROBERT ZARRANZ
Title or Position: OWNER
Credential: MD
Phone: 239-349-2500