Provider Demographics
NPI:1114040433
Name:BALTAZAR, MAGDALENA ASUNCION
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:ASUNCION
Last Name:BALTAZAR
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 1:94-904 KUAKAHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2808
Mailing Address - Country:US
Mailing Address - Phone:180-867-7496
Mailing Address - Fax:
Practice Address - Street 1:94-904 KUAKAHI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2808
Practice Address - Country:US
Practice Address - Phone:180-867-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications