Organization
BALBOA NEPHROLOGY MED GRP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WENCESLAO (CONTRACTS & CREDENTIALING)
(858) 810-8000
Entity
Organization
Contact information
Practice address
2205 ROSS AVE, SUITE 101, EL CENTRO, CA 92243-3623
(760) 353-0404
(760) 353-0392
Mailing address
9373 HAZARD WAY STE 200, SAN DIEGO, CA 92123-1226
(858) 810-8000
(858) 268-1911
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0103520
—
CA
Enumeration date
02/05/2008
Last updated
01/16/2026
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