Provider Demographics
NPI:1811791304
Name:BALBOA NEPHROLOGY ASSOCIATES
Entity type:Organization
Organization Name:BALBOA NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-454-1127
Mailing Address - Street 1:6402 EL CAJON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2645
Mailing Address - Country:US
Mailing Address - Phone:619-582-4490
Mailing Address - Fax:619-582-4737
Practice Address - Street 1:6402 EL CAJON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2645
Practice Address - Country:US
Practice Address - Phone:619-582-4490
Practice Address - Fax:619-582-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical