Healthcare Provider Details

I. General information

NPI: 1952351686
Provider Name (Legal Business Name): SAN MARCOS MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 ARLINGTON AVE
RIVERSIDE CA
92504-2757
US

IV. Provider business mailing address

4990 ARLINGTON AVE
RIVERSIDE CA
92504-2757
US

V. Phone/Fax

Practice location:
  • Phone: 951-785-9011
  • Fax: 951-785-9011
Mailing address:
  • Phone: 951-785-9011
  • Fax: 951-785-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGR0086723
License Number StateCA

VIII. Authorized Official

Name: NATT BALBIR
Title or Position: MD/ PRESIDENT
Credential: MD
Phone: 951-751-5470