BALBOA NEPHROLOGY MED GRP INC NPI 1750569489

NPI Information

  • NPI: 1750569489
  • Provider Name: BALBOA NEPHROLOGY MED GRP INC
  • Classification: Internal Medicine - 207RN0300X
  • Specialization: Nephrology
  • Entity Type: Organization
  • CLIA Number: 05D0707199
  • Address: 2205 ROSS AVE
    SUITE 101
    EL CENTRO, CA
    ZIP 92243
  • Phone: (760) 353-0404

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NPI Details

BALBOA NEPHROLOGY MED GRP INC is a nephrology internal medicine in El Centro, CA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. BALBOA NEPHROLOGY MED GRP INC NPI is 1750569489. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2205 ROSS AVE
SUITE 101
EL CENTRO, CA
ZIP 92243-623
Phone: (760) 353-0404
Fax: (760) 353-0392

The provider's authorized official is Stephanie Wenceslao .
The authorized official title is Contracts & Credentialing and has the following contact phone number (858) 810-8000.

The CLIA number assigned to this NPI record is 05D0707199 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/5/2008 and was last updated on 2/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RN0300XInternal MedicineNephrologyCALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GR0103520MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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