Provider Demographics
NPI:1932171121
Name:BALCOS, ENRICO URO (MD)
Entity Type:Individual
Prefix:
First Name:ENRICO
Middle Name:URO
Last Name:BALCOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:626-226-5853
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:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA633632084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA464756OtherVALUE OPTIONS
CA3082293OtherCIGNA
CA1127910OtherBEACON HEALTH STRATEGIES
CA2123606OtherUHC
CA484315000OtherMAGELLAN BEHAVIORAL HEALTH
CA247792OtherMHN
CA00A633630Medicaid