Life Balance Medical Group LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Tampa, FL. Organization (NPI-2).
Details
- NPI
- 1336775733
- Entity type
- Organization (NPI-2)
- Legal business name
- Life Balance Medical Group LLC
- Organization subpart
- No
- Enumeration date
- Mar 17, 2020
- Certification date
- Sep 21, 2021
- Last updated
- Sep 21, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
2916 W Waters Ave Ste A1Tampa, FL 33614-1869
Phone 813-443-8221 · Fax 813-443-1869
Mailing address
Po Box 151686Tampa, FL 33684-1686
Phone 813-443-8221 · Fax 813-443-1869
Authorized official
Pedro M Hernandez
Owner
8134438221
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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