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General NPI Number Information
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NPI Number | 1518268895
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Entity Type | Organization
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Legal Business Name | LIZ BALES, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 1301 N ROSE DR
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City | PLACENTIA
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State | CA
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Zip | 92870-3802
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Country | US
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Telephone | 714-524-4252
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Fax | 714-524-4866
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Provider Business Mailing Address
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Address Line | 3226 BROAD ST
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4224
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Country | US
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Telephone | 949-410-4207
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Fax | 310-807-2318
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH BALES
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Credential | M.D.
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Telephone | 949-410-4207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A91889
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License Number State | CA
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