Provider Demographics
NPI:1861878597
Name:BIOMD BALANCE SOLUTIONS
Entity type:Organization
Organization Name:BIOMD BALANCE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREGOVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-994-1966
Mailing Address - Street 1:2716 TRAPPER SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-6261
Mailing Address - Country:US
Mailing Address - Phone:717-994-1966
Mailing Address - Fax:801-780-6316
Practice Address - Street 1:17777 VENTURA BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3736
Practice Address - Country:US
Practice Address - Phone:717-994-1966
Practice Address - Fax:801-780-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty