MEDICARE: BALBOA NEPHROLOGY MEDICAL GROUP,INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1598276404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALBOA NEPHROLOGY MEDICAL GROUP,INC.

Provider Business Mailing Address
First Line	:	9373 HAZARD WAY STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1226
Country	:	US
Telephone Number	:	858-810-0000
Fax Number	:	858-268-1911

Provider Business Practice Location Address
First Line	:	6402 EL CAJON BLVD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-2645
Country	:	US
Telephone Number	:	619-582-4490
Fax Number	:	619-582-4737

Authorized Official
Title or Position	:	MEDICAL DIRECTOR & AO
Name	:	DAVID S NAMAZY
Credential	:	MD
Telephone Number	:	619-582-4490

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	01/16/2026

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