Provider Demographics
NPI:1982001277
Name:BLUE ZONE HEALTH
Entity type:Organization
Organization Name:BLUE ZONE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-557-1767
Mailing Address - Street 1:1411 N FLAGLER DR STE 7200
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3418
Mailing Address - Country:US
Mailing Address - Phone:561-557-1767
Mailing Address - Fax:
Practice Address - Street 1:1411 N FLAGLER DR STE 7200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3418
Practice Address - Country:US
Practice Address - Phone:561-557-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99506261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care