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General NPI Number Information
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NPI Number | 1811791304
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Entity Type | Organization
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Legal Business Name | BALBOA NEPHROLOGY ASSOCIATES
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 6402 EL CAJON BLVD STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92115-2645
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Country | US
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Telephone | 619-582-4490
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Fax | 619-582-4737
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Provider Business Mailing Address
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Address Line | 6402 EL CAJON BLVD STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92115-2645
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Country | US
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Telephone | 619-582-4490
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Fax | 619-582-4737
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Authorized Official
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Title or Position | CFO
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Name | SHAUN EDELSTEIN
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Credential |
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Telephone | 619-454-1127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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