Healthcare Provider Details

I. General information

NPI: 1194661868
Provider Name (Legal Business Name): DAMIEN GONZALO BALBOA CESPEDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3046
US

IV. Provider business mailing address

27334 ENGLISH OAK CT
CANYON COUNTRY CA
91387-6869
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1121
  • Fax:
Mailing address:
  • Phone: 661-998-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: