Provider Demographics
NPI:1770786881
Name:BALDWIN, ERIN LEIGH (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10968
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0968
Mailing Address - Country:US
Mailing Address - Phone:805-384-8071
Mailing Address - Fax:805-484-3610
Practice Address - Street 1:5051 VERDUGO WAY STE 110
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8680
Practice Address - Country:US
Practice Address - Phone:805-384-8071
Practice Address - Fax:805-484-3610
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55868YOtherBS/TRIWEST
CAA97418OtherSTATE LICENSE
CA1770786881Medicaid
CAW21724Medicare PIN