Enrico Balcos Medical Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A63363 Issued in CA

Legal business name

ENRICO BALCOS MEDICAL INC

Practice address

4619 Rosemead Blvd
Rosemead, CA 91770-1478

Phone

(626) 286-1191

Fax

(949) 258-5551

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Enrico U Balcos, MD

Title

Corp President

Phone

(888) 518-5445

Specialties & licenses 1

Addresses

Other identifiers 6

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1578585576",
    "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": "888-518-5445",
            "fax_number": "949-258-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4619 ROSEMEAD BLVD",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917701478",
            "telephone_number": "626-286-1191",
            "fax_number": "949-258-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENRICO BALCOS MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "BALCOS",
        "authorized_official_first_name": "ENRICO",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "CORP PRESIDENT",
        "authorized_official_telephone_number": "888-518-5445",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A63363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ56941Y",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "247792",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR CANYON RIDGE HOSP",
            "identifier": "1902825128",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA LICENSED",
            "identifier": "A63363",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A633630",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR BHC HOSPITAL",
            "identifier": "1194758623",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Rosemead, CA
• Providers in Rosemead, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; 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.