Provider Demographics
NPI:1861200792
Name:BODY BALANCE HEALTH AND AESTHETICS MEDICINE
Entity type:Organization
Organization Name:BODY BALANCE HEALTH AND AESTHETICS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AZAMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-747-2000
Mailing Address - Street 1:1905 SE 192ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7415
Mailing Address - Country:US
Mailing Address - Phone:360-747-2000
Mailing Address - Fax:
Practice Address - Street 1:1905 SE 192ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7415
Practice Address - Country:US
Practice Address - Phone:360-747-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty