Provider Demographics
NPI:1841577426
Name:BALDIS, MARK WILEY (PHD, RCEP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILEY
Last Name:BALDIS
Suffix:
Gender:M
Credentials:PHD, RCEP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5275 N CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93740-0001
Mailing Address - Country:US
Mailing Address - Phone:559-278-8896
Mailing Address - Fax:559-278-7010
Practice Address - Street 1:5275 N CAMPUS DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-8896
Practice Address - Fax:559-278-7010
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist