Provider Demographics
NPI:1295851392
Name:BALTZ, TRUDY MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRUDY
Middle Name:MARIA
Last Name:BALTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 OAK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1000
Mailing Address - Country:US
Mailing Address - Phone:530-758-3178
Mailing Address - Fax:530-757-2043
Practice Address - Street 1:1621 OAK AVE STE B
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1000
Practice Address - Country:US
Practice Address - Phone:530-758-3178
Practice Address - Fax:530-757-2043
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14497103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist