Individual
MARYAM BALOUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1955 CITRACADO PKWY, SUITE 300, ESCONDIDO, CA 92029-4110
(760) 743-0546
(760) 743-8837
Mailing address
15611 POMERADO RD, SUITE 400, POWAY, CA 92064-2437
(858) 675-3100
(858) 618-1523
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A121988
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113998
SID # 113998
CA
Enumeration date
02/24/2012
Last updated
03/25/2024
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