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General NPI Number Information
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NPI Number | 1861878597
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Entity Type | Organization
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Legal Business Name | BIOMD BALANCE SOLUTIONS
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 17777 VENTURA BLVD SUITE #120
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City | ENCINO
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State | CA
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Zip | 91316-3736
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Country | US
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Telephone | 717-994-1966
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Fax | 801-780-6316
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Provider Business Mailing Address
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Address Line | 2716 TRAPPER SPRINGS AVE
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City | TULARE
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State | CA
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Zip | 93274-6261
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Country | US
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Telephone | 717-994-1966
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Fax | 801-780-6316
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Authorized Official
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Title or Position | CEO
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Name | DR. OLGA BEREGOVSKAYA
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Credential | MD
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Telephone | 717-994-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A93529
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License Number State | CA
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