MEDICARE: BALBOA NEPHROLOGY ASSOCIATES

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	:	1811791304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALBOA NEPHROLOGY ASSOCIATES

Provider Business Mailing 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

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	:	CFO
Name	:	SHAUN EDELSTEIN
Credential	:
Telephone Number	:	619-454-1127

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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