Organization
BALBOA RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN CULLEN (CHIEF EXECUTIVE OFFICER)
(949) 400-7120
Entity
Organization
Contact information
Practice address
3419 VIA LIDO, NEWPORT BEACH, CA 92663-3908
(949) 723-2388
Mailing address
204 21ST ST, NEWPORT BEACH, CA 92663-4372
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
10/25/2012
Last updated
10/25/2012
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