Organization
LIFE BALANCE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEDRO M HERNANDEZ (OWNER)
(813) 443-8221
Entity
Organization
Contact information
Practice address
2916 W WATERS AVE STE A1, TAMPA, FL 33614-1869
(813) 443-8221
(813) 443-1869
Mailing address
PO BOX 151686, TAMPA, FL 33684-1686
(813) 443-8221
(813) 443-1869
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/17/2020
Last updated
09/21/2021
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