| Enrico Balcos Medical Inc | |
|
4619 Rosemead Blvd Rosemead CA 91770-1478 | |
| (626) 286-1191 | |
| (949) 258-5551 |
| Full Name | Enrico Balcos Medical Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4619 Rosemead Blvd, Rosemead, California |
| Authorized Official Name and Position | Enrico U Balcos (CORP PRESIDENT) |
| Authorized Official Contact | 8885185445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enrico Balcos Medical Inc Po Box 1526 South Pasadena CA 91031-1526 Ph: (888) 518-5445 | Enrico Balcos Medical Inc 4619 Rosemead Blvd Rosemead CA 91770-1478 Ph: (626) 286-1191 |
| NPI Number | 1578585576 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 09/09/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578585576 | NPI | - | NPPES |
| ZZZ56941Y | Other | CA | BLUE SHIELD OF CALIFORNIA |
| 247792 | Other | CA | MHN |
| 1902825128 | Other | CA | NPI FOR CANYON RIDGE HOSP |
| A63363 | Other | CA | CA LICENSED |
| 00A633630 | Medicaid | CA | |
| 1194758623 | Other | CA | NPI FOR BHC HOSPITAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A63363 (California) | Primary |
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