Provider Demographics
NPI:1619653649
Name:BALDERAS, EVAMARIE TERESA (DAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:EVAMARIE
Middle Name:TERESA
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:DAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N FLORAL ST STE D
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4957
Mailing Address - Country:US
Mailing Address - Phone:559-936-2156
Mailing Address - Fax:
Practice Address - Street 1:204 N FLORAL ST STE D
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4957
Practice Address - Country:US
Practice Address - Phone:559-936-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000268382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer