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General NPI Number Information
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NPI Number | 1518478643
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Entity Type | Organization
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Legal Business Name | EB PSYCH SOLUTION, INC.
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 11/11/2017
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 714-875-3443
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Fax | 714-948-8248
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Provider Business Mailing Address
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Address Line | 1125 E 17TH ST N354
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 714-875-3443
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Fax | 714-948-8248
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Authorized Official
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Title or Position | PRESIDENT
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Name | ENRICO BALCOS
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Credential | MD
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Telephone | 714-875-3443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry
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License Number | A63633
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License Number State | CA
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