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General NPI Number Information
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NPI Number | 1205599149
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Entity Type | Organization
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Legal Business Name | BALBOA SURGICAL ASSOCIATES INC.
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 2501 E CHAPMAN AVE STE 220
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City | FULLERTON
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State | CA
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Zip | 92831-3108
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Country | US
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Telephone | 949-872-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 129 LESSAY
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City | NEWPORT COAST
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State | CA
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Zip | 92657-1043
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Country | US
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Telephone | 949-872-5192
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DIANA HART
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Credential |
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Telephone | 949-872-5192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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