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General NPI Number Information
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NPI Number | 1215201108
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Entity Type | Individual
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Provider Name | MARYAM BALOUCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 1955 CITRACADO PKWY SUITE 300
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City | ESCONDIDO
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State | CA
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Zip | 92029-4110
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Country | US
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Telephone | 760-743-0546
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Fax | 760-743-8837
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Provider Business Mailing Address
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Address Line | 15611 POMERADO RD SUITE 400
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City | POWAY
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State | CA
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Zip | 92064-2437
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Country | US
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Telephone | 858-675-3100
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Fax | 858-618-1523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A121988
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License Number State | CA
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