Provider Demographics
NPI:1487039756
Name:BALDERAS, MARIA GUADALUPE
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:GUADALUPE
Other - Last Name:CARDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STUDENT/INTERN
Mailing Address - Street 1:622 SW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-2512
Mailing Address - Country:US
Mailing Address - Phone:405-414-3026
Mailing Address - Fax:
Practice Address - Street 1:420 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-5610
Practice Address - Country:US
Practice Address - Phone:405-236-0701
Practice Address - Fax:405-236-0737
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program