# BALBOA SURGICAL ASSOCIATES INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205599149
- **Authorized official:** DIANA HART (BILLING MANAGER)
- **Authorized official phone:** (949) 872-5192

## Contact information

- **Practice address:** 2501 E CHAPMAN AVE STE 220, FULLERTON, CA 92831-3108
- **Practice address phone:** (949) 872-5192
- **Mailing address:** 129 LESSAY, NEWPORT COAST, CA 92657-1043
- **Mailing address phone:** (949) 872-5192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2021
- **Last updated:** 10/18/2021