Provider Demographics
NPI:1083029599
Name:BALDEMIAN, MARTA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:BALDEMIAN
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 1:408 S ROSEMEAD BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4976
Mailing Address - Country:US
Mailing Address - Phone:626-398-0195
Mailing Address - Fax:
Practice Address - Street 1:408 S ROSEMEAD BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4976
Practice Address - Country:US
Practice Address - Phone:626-398-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405830251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based