Organization
EBMD, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ENRICO URO BALCOS M.D. (PRESIDENT)
(949) 545-1121
Entity
Organization
Contact information
Practice address
5353 G ST, CHINO, CA 91710-5249
(909) 590-3700
Mailing address
PO BOX 1526, SOUTH PASADENA, CA 91031-1526
(949) 545-1121
(949) 258-5551
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A63363
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A633630
—
CA
Enumeration date
01/17/2014
Last updated
01/18/2014
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