Healthcare Provider Details

I. General information

NPI: 1518268895
Provider Name (Legal Business Name): LIZ BALES, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 BROAD ST
NEWPORT BEACH CA
92663-4224
US

IV. Provider business mailing address

3226 BROAD ST
NEWPORT BEACH CA
92663-4224
US

V. Phone/Fax

Practice location:
  • Phone: 949-410-4207
  • Fax: 310-807-2318
Mailing address:
  • Phone: 949-410-4207
  • Fax: 310-807-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA91889
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH ANDREA BALES
Title or Position: OWNER
Credential: MD
Phone: 714-494-9619