NPIMap

Organization Active NPI

Ebmd, P.C.

  • Psychiatry Physician
  • Chino, CA
National Provider Identifier
1003238510
Registry record updated Jan 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A63363 Issued in CA
Legal business name
EBMD, P.C.
Practice address
5353 G St
Chino, CA 91710-5249
Phone
(909) 590-3700
NPI assigned
Jan 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Enrico Uro Balcos, M.D.
Title
President
Phone
(949) 545-1121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X A63363 CA Primary

Addresses

Primary practice location

5353 G St
Chino, CA 91710-5249

Mailing address

PO Box 1526
South Pasadena, CA 91031-1526
Phone (949) 545-1121

Other identifiers 1

IdentifierTypeStateIssuer
00A633630MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390003200000",
    "number": "1003238510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1526",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910311526",
            "telephone_number": "949-545-1121",
            "fax_number": "949-258-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 G ST",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917105249",
            "telephone_number": "909-590-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBMD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-17",
        "last_updated": "2014-01-18",
        "status": "A",
        "authorized_official_last_name": "BALCOS",
        "authorized_official_first_name": "ENRICO",
        "authorized_official_middle_name": "URO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-545-1121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A63363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A633630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.