Basic Information
| Provider Information | |||||||||
| NPI: | 1891948196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALDEO | ||||||||
| FirstName: | NOLI | ||||||||
| MiddleName: | CANTUBA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 MEDICAL PKWY | ||||||||
| Address2: | BUILDING B, SUITE 220 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123244083 | ||||||||
| FaxNumber: | 5123244717 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 SETON PKWY | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786658000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134415114 | ||||||||
| FaxNumber: | 7137906615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2008 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TMB PIT # BP10031324 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | P4285 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 314797702 | 05 | TX | MEDICAID | 314797704 | 05 | TX | MEDICAID | 314797701 | 05 | TX | MEDICAID | 314797703 | 05 | TX | MEDICAID |