Provider Demographics
NPI:1073945762
Name:BALDWIN, TONYA MARIA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIA
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7649 CONCORD HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1600
Mailing Address - Country:US
Mailing Address - Phone:702-557-0265
Mailing Address - Fax:
Practice Address - Street 1:7649 CONCORD HEIGHTS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1600
Practice Address - Country:US
Practice Address - Phone:702-557-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health