Organization
ENRICO BALCOS MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENRICO U BALCOS MD (CORP PRESIDENT)
(888) 518-5445
Entity
Organization
Contact information
Practice address
4619 ROSEMEAD BLVD, ROSEMEAD, CA 91770-1478
(626) 286-1191
(949) 258-5551
Mailing address
PO BOX 1526, SOUTH PASADENA, CA 91031-1526
(888) 518-5445
(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
01
—
1194758623
NPI FOR BHC HOSPITAL
CA
01
—
1902825128
NPI FOR CANYON RIDGE HOSP
CA
01
—
247792
MHN
CA
01
—
A63363
CA LICENSED
CA
01
—
ZZZ56941Y
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/25/2006
Last updated
09/09/2011
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