Provider Demographics
NPI:1073783114
Name:UBALDO, EDUARD BALDO
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:BALDO
Last Name:UBALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 SAMOS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4029
Mailing Address - Country:US
Mailing Address - Phone:916-427-3356
Mailing Address - Fax:
Practice Address - Street 1:3820 SAMOS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4029
Practice Address - Country:US
Practice Address - Phone:916-427-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB7552782343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)