Healthcare Provider Details

I. General information

NPI: 1215831185
Provider Name (Legal Business Name): BALBOA SURGERY AND CLINICAL RESEARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 NEWPORT AVE STE E
TUSTIN CA
92780-3745
US

IV. Provider business mailing address

21163 NEWPORT COAST DR PO BOX 294
NEWPORT COAST CA
92657-1123
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENJAMIN MICHAEL SAVASKY
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 248-808-9072