Provider Demographics
NPI:1033564109
Name:BALDIVIA, PAMELA SUE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA SUE
Middle Name:
Last Name:BALDIVIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAMELA SUE
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:SUITE B790A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7404
Practice Address - Country:US
Practice Address - Phone:310-267-3894
Practice Address - Fax:310-267-3894
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily