Provider Demographics
NPI:1831399740
Name:BALDRIAS, PERCIVAL JOHN (NP)
Entity type:Individual
Prefix:MR
First Name:PERCIVAL
Middle Name:JOHN
Last Name:BALDRIAS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N MOUNTAIN AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4163
Mailing Address - Country:US
Mailing Address - Phone:909-920-5150
Mailing Address - Fax:909-694-1385
Practice Address - Street 1:820 N MOUNTAIN AVE STE 215
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4163
Practice Address - Country:US
Practice Address - Phone:909-920-5150
Practice Address - Fax:909-694-1385
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571590163WP0808X
CA16510363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health