Provider Demographics
NPI:1295079259
Name:BALDONADO, RICHARD S (RVT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:BALDONADO
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3534 SANTA CARLOTTA ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1115
Mailing Address - Country:US
Mailing Address - Phone:818-957-1652
Mailing Address - Fax:818-957-4672
Practice Address - Street 1:3534 SANTA CARLOTTA ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1115
Practice Address - Country:US
Practice Address - Phone:818-957-1652
Practice Address - Fax:818-957-4672
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80940246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist