Basic Information
| Provider Information | |||||||||
| NPI: | 1861700478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | P. JOHN BALDRIAS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11741 TELEGRAPH RD STE G | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11741 TELEGRAPH RD STE G | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | BALDRIAS | ||||||||
| AuthorizedOfficialFirstName: | PERCIVAL | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 9092033523 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 16510 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.