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Organization
BALBOA NEPHROLOGY MEDICAL GROUP, INC.
Active
Organization
BALBOA NEPHROLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN EDELSTEIN (CFO)
(858) 810-8000
Entity
Organization
Contact information
Practice address
9373 HAZARD WAY STE 200, SAN DIEGO, CA 92123-1226
(858) 810-8000
(858) 268-1911
Mailing address
9373 HAZARD WAY STE 200, SAN DIEGO, CA 92123-1226
(858) 810-0000
(858) 268-1911
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
—
—
207RN0300X
Nephrology Physician
Primary
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB251966
MEDICARE PTAN ORANGE COUNTY
CA
01
—
W1487
MEDICARE PTAN, SO CA
CA
01
—
ZZZ04938Z
MEDICARE PTAN, NO CA
CA
Enumeration date
05/11/2006
Last updated
02/09/2026
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