Provider Demographics
NPI:1215903612
Name:BALANCE PAIN MANAGEMENT
Entity type:Organization
Organization Name:BALANCE PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-988-9333
Mailing Address - Street 1:240 LA CASA VIA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-988-9333
Mailing Address - Fax:925-988-9335
Practice Address - Street 1:240 LA CASA VIA
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-988-9333
Practice Address - Fax:925-988-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85784208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G857841Medicare ID - Type Unspecified
G75605Medicare UPIN