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General NPI Number Information
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NPI Number | 1790654945
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Entity Type | Organization
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Legal Business Name | BLALANCE4LIFE
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 7951 ETIWANDA AVE APT 2104 2104
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-6701
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Country | US
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Telephone | 909-276-4393
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Fax |
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Provider Business Mailing Address
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Address Line | 7951 ETIWANDA AVE APT 2104
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-6701
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Country | US
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Telephone | 909-276-4393
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ANTHONY ALLEN
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Credential |
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Telephone | 909-276-4393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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