Healthcare Provider Details

I. General information

NPI: 1114753761
Provider Name (Legal Business Name): INNER BALANCE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13190 SW 134TH ST STE 106
MIAMI FL
33186-4496
US

IV. Provider business mailing address

11125 SW 243RD ST
HOMESTEAD FL
33032-5148
US

V. Phone/Fax

Practice location:
  • Phone: 786-209-0023
  • Fax:
Mailing address:
  • Phone: 786-209-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA DIAZ
Title or Position: OWNER
Credential: APRN/PMHNP-BC
Phone: 786-222-9194