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General NPI Number Information
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NPI Number | 1447446448
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Entity Type | Organization
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Legal Business Name | SAN MARCOS MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 14980 SUMMIT AVE STE 230
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City | FONTANA
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State | CA
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Zip | 92336-5390
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Country | US
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Telephone | 909-376-4438
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Fax | 909-881-7329
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Provider Business Mailing Address
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Address Line | 14980 SUMMIT AVE STE 230
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City | FONTANA
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State | CA
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Zip | 92336-5390
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Country | US
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Telephone | 909-376-4438
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Fax | 909-881-7329
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | NATT BALBIR
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Credential | MD
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Telephone | 909-376-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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