MEDICARE: SAN MARCOS 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	207Q00000X	Family Medicine Physician	GR0086723	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952351686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN MARCOS MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	4990 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2757
Country	:	US
Telephone Number	:	951-785-9011
Fax Number	:	951-785-9011

Provider Business Practice Location Address
First Line	:	4990 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2757
Country	:	US
Telephone Number	:	951-785-9011
Fax Number	:	951-785-9011

Authorized Official
Title or Position	:	MD/ PRESIDENT
Name	:	NATT BALBIR
Credential	:	MD
Telephone Number	:	951-751-5470

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	04/29/2022

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