Provider Demographics
NPI:1659678274
Name:BALBAS MEDICAL, P.C
Entity Type:Organization
Organization Name:BALBAS MEDICAL, P.C
Other - Org Name:CORONA PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BALBAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-735-3553
Mailing Address - Street 1:1150 EL CAMINO AVE
Mailing Address - Street 2:SUITE108
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1784
Mailing Address - Country:US
Mailing Address - Phone:951-735-3553
Mailing Address - Fax:951-735-3558
Practice Address - Street 1:1150 EL CAMINO AVE
Practice Address - Street 2:SUITE108
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1784
Practice Address - Country:US
Practice Address - Phone:951-735-3553
Practice Address - Fax:951-735-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA890362081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty