Provider Demographics
NPI:1003553041
Name:BAYNADO, JOSEPHINE PANCHO
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:PANCHO
Last Name:BAYNADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11517 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9508
Mailing Address - Country:US
Mailing Address - Phone:559-530-4035
Mailing Address - Fax:559-583-9307
Practice Address - Street 1:11517 15TH AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9508
Practice Address - Country:US
Practice Address - Phone:559-530-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator