Healthcare Provider Details

I. General information

NPI: 1871872242
Provider Name (Legal Business Name): ANNAMARIE PAMPHILIS RDH, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31015 CENTER RIDGE RD. HEALTH AND BALANCE INSTITUTE, LLC
WESTLAKE OH
44145
US

IV. Provider business mailing address

4801 SPRUCEWOOD ST
AVON OH
44011-2716
US

V. Phone/Fax

Practice location:
  • Phone: 440-539-0392
  • Fax:
Mailing address:
  • Phone: 440-539-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number31009182
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: