Healthcare Provider Details

I. General information

NPI: 1689185159
Provider Name (Legal Business Name): NEXTGEN TREATMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 N IMPERIAL AVE STE D
EL CENTRO CA
92243-1607
US

IV. Provider business mailing address

9880 N MAGNOLIA AVE STE 200
SANTEE CA
92071-1901
US

V. Phone/Fax

Practice location:
  • Phone: 760-693-5372
  • Fax: 760-693-5375
Mailing address:
  • Phone: 619-916-3177
  • Fax: 619-757-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE BALKCOM
Title or Position: ADMINISTRATOR
Credential:
Phone: 888-268-8607