Provider Demographics
NPI:1265707764
Name:BALTAZAR, MARIA DONNA (MOTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DONNA
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 W LINCOLN AVE
Mailing Address - Street 2:APT 333
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6760
Mailing Address - Country:US
Mailing Address - Phone:562-455-5688
Mailing Address - Fax:
Practice Address - Street 1:501 S BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1810
Practice Address - Country:US
Practice Address - Phone:714-816-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 10247225XG0600X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology