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General NPI Number Information
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NPI Number | 1467106955
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Entity Type | Organization
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Legal Business Name | BALANCED HEALTHCARE OF TEXAS LLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 4000
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 210-909-4409
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Fax | 210-615-9078
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Provider Business Mailing Address
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Address Line | 12315 STABLE PASS
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City | SAN ANTONIO
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State | TX
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Zip | 78249-4623
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Country | US
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Telephone | 210-909-4409
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | VIVIAN PALACIOS JONES
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Credential |
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Telephone | 210-909-4409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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