Provider Demographics
NPI:1023359288
Name:BALDES, MINDY L (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:BALDES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 VAN NESS WAY STE 90
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:369 VAN NESS WAY
Practice Address - Street 2:SUITE 710
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1489
Practice Address - Country:US
Practice Address - Phone:310-787-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-5740103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst