Provider Demographics
NPI:1720474000
Name:BALDONADO, ANGELO ALAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:ALAN
Last Name:BALDONADO
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 NW 72ND WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1047
Mailing Address - Country:US
Mailing Address - Phone:954-257-0605
Mailing Address - Fax:
Practice Address - Street 1:2260 NW 72ND WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-1047
Practice Address - Country:US
Practice Address - Phone:954-257-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 14047224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant