Provider Demographics
NPI:1578628855
Name:BALTASAR ENTERPRISES INC.
Entity Type:Organization
Organization Name:BALTASAR ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTASAR
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, LD
Authorized Official - Phone:405-826-2023
Mailing Address - Street 1:PO BOX 850894
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73085-0894
Mailing Address - Country:US
Mailing Address - Phone:405-826-2023
Mailing Address - Fax:405-354-1073
Practice Address - Street 1:729 HAMLET CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4401
Practice Address - Country:US
Practice Address - Phone:405-826-2023
Practice Address - Fax:405-654-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD 222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty