Provider Demographics
NPI:1184320335
Name:BALDOVINO, RONALIE (OD)
Entity type:Individual
Prefix:
First Name:RONALIE
Middle Name:
Last Name:BALDOVINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 DUNE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2058
Mailing Address - Country:US
Mailing Address - Phone:562-277-2677
Mailing Address - Fax:
Practice Address - Street 1:5531 E STEARNS ST STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3125
Practice Address - Country:US
Practice Address - Phone:562-596-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist