Healthcare Provider Details

I. General information

NPI: 1164556353
Provider Name (Legal Business Name): DAVID G.R. BALCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FOURTH AVE STE 440
SAN DIEGO CA
92103-2183
US

IV. Provider business mailing address

1325 N. ROSE DR STE 210
PLACENTIA CA
92870-3800
US

V. Phone/Fax

Practice location:
  • Phone: 619-298-8891
  • Fax: 619-298-4997
Mailing address:
  • Phone: 714-961-5804
  • Fax: 714-961-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number38051
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: