Provider Demographics
NPI:1407149297
Name:EDWARD A. BALBAS, P.C.
Entity Type:Organization
Organization Name:EDWARD A. BALBAS, P.C.
Other - Org Name:OC BACK & BODY DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-724-0011
Mailing Address - Street 1:17264 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5628
Mailing Address - Country:US
Mailing Address - Phone:949-724-0011
Mailing Address - Fax:949-724-0012
Practice Address - Street 1:17264 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5628
Practice Address - Country:US
Practice Address - Phone:949-724-0011
Practice Address - Fax:949-724-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89036208100000X
CAPT35232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty