Healthcare Provider Details

I. General information

NPI: 1720822133
Provider Name (Legal Business Name): NARGES BALUCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 444
LA MESA CA
91942-3020
US

IV. Provider business mailing address

17989 PUEBLO VISTA LN
SAN DIEGO CA
92127-1279
US

V. Phone/Fax

Practice location:
  • Phone: 858-226-8805
  • Fax: 877-497-6008
Mailing address:
  • Phone: 858-226-8805
  • Fax: 877-497-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA194946
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA194946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: