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General NPI Number Information
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NPI Number | 1386299675
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Entity Type | Organization
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Legal Business Name | BALANCE & WELLBEING, LLC
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1051 PERIMETER DR STE 1100
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City | SCHAUMBURG
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State | IL
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Zip | 60173-5079
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Country | US
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Telephone | 630-344-9617
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Fax | 847-648-4122
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | CAMAS
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State | WA
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Zip | 98607-0699
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Country | US
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Telephone | 360-903-1829
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Fax | 360-991-0337
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. JOVEL BROQUEZA
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Credential | APRN
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Telephone | 630-344-9617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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