Provider Demographics
NPI:1518478643
Name:EB PSYCH SOLUTION, INC.
Entity Type:Organization
Organization Name:EB PSYCH SOLUTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:URO
Authorized Official - Last Name:BALCOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-268-9480
Mailing Address - Street 1:122A E FOOTHILL BLVD # 338
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2505
Mailing Address - Country:US
Mailing Address - Phone:626-268-9480
Mailing Address - Fax:
Practice Address - Street 1:4619 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1478
Practice Address - Country:US
Practice Address - Phone:626-268-9480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA636332084P0800X
CAA633632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty