Provider Demographics
NPI:1730673062
Name:BALDASSARRE, ROBERTO RAFAEL (MPAS)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:RAFAEL
Last Name:BALDASSARRE
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3293 GREENWALD WAY N
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0772
Mailing Address - Country:US
Mailing Address - Phone:801-860-2925
Mailing Address - Fax:
Practice Address - Street 1:3293 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0772
Practice Address - Country:US
Practice Address - Phone:801-860-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical