Provider Demographics
NPI:1104608223
Name:MEN & WOMEN'S BALANCED WELLNESS, LLC
Entity type:Organization
Organization Name:MEN & WOMEN'S BALANCED WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP/ DIRECTOR OF OPERATIONS & STAFF
Authorized Official - Prefix:MS
Authorized Official - First Name:SUHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARRN
Authorized Official - Phone:609-742-1449
Mailing Address - Street 1:3004 NW 130TH TER APT 142
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3945
Mailing Address - Country:US
Mailing Address - Phone:609-742-1449
Mailing Address - Fax:954-807-3139
Practice Address - Street 1:9750 NW 33RD ST STE 111
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4000
Practice Address - Country:US
Practice Address - Phone:609-742-1449
Practice Address - Fax:954-807-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty