Provider Demographics
NPI:1235293127
Name:BALDONADO, JESUS PULIDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:PULIDO
Last Name:BALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2203
Mailing Address - Country:US
Mailing Address - Phone:661-721-0737
Mailing Address - Fax:661-721-0738
Practice Address - Street 1:1201 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2203
Practice Address - Country:US
Practice Address - Phone:661-721-0737
Practice Address - Fax:661-721-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68306207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G683060Medicaid
00G683060Medicare ID - Type Unspecified
CA00G683060Medicaid