Provider Demographics
NPI:1275006173
Name:BALBOA SURGICAL INSTITUTE, INC.
Entity Type:Organization
Organization Name:BALBOA SURGICAL INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOBECKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:858-576-1011
Mailing Address - Street 1:7625 MESA COLLEGE DRIVE
Mailing Address - Street 2:SUITE 315A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5343
Mailing Address - Country:US
Mailing Address - Phone:858-576-1011
Mailing Address - Fax:858-576-1025
Practice Address - Street 1:7625 MESA COLLEGE DRIVE
Practice Address - Street 2:SUITE 315A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-576-1011
Practice Address - Fax:858-576-1025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS DOBECKI, M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical