Basic Information
| Provider Information | |||||||||
| NPI: | 1265707764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALTAZAR | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DONNA | ||||||||
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| Credential: | MOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1780 W LINCOLN AVE | ||||||||
| Address2: | APT 333 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928016760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624555688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 S BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928041810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148160540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2012 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XG0600X | OT 10247 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | 225XP0019X | OT 10247 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.