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General NPI Number Information
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NPI Number | 1629490297
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Entity Type | Organization
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Legal Business Name | BALBAS INTEGRATED MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1618 SULLIVAN AVE 208
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City | DALY CITY
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State | CA
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Zip | 94015-1967
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Country | US
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Telephone | 707-824-4203
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 SULLIVAN AVE 525
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City | DALY CITY
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State | CA
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Zip | 94015-1967
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Country | US
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Telephone | 707-824-4203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGELITA G. BALBAS
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Credential | M.D.
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Telephone | 707-824-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A83354
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License Number State | CA
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