Provider Demographics
NPI:1558952390
Name:OSTEOPATHIC HEALTH OF BALDWIN PARK
Entity Type:Organization
Organization Name:OSTEOPATHIC HEALTH OF BALDWIN PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-506-4776
Mailing Address - Street 1:4625 HALDER LN STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6416
Mailing Address - Country:US
Mailing Address - Phone:407-506-4776
Mailing Address - Fax:407-203-4018
Practice Address - Street 1:4625 HALDER LN STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6416
Practice Address - Country:US
Practice Address - Phone:407-506-4776
Practice Address - Fax:407-203-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty