Organization
BALBOA NEPHROLOGY MEDICAL GROUP,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WENCESLAO (CONTRACTS & CREDENTIALING)
(858) 810-8000
Entity
Organization
Contact information
Practice address
790 W ORANGE AVE, STE B, EL CENTRO, CA 92243-3274
(760) 353-0404
(760) 353-5391
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
Enumeration date
01/28/2008
Last updated
01/16/2026
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