Provider Demographics
NPI:1841698610
Name:BALTAZAR, AARON CARL (OTR/L)
Entity type:Individual
Prefix:
First Name:AARON CARL
Middle Name:
Last Name:BALTAZAR
Suffix:
Gender:M
Credentials:OTR/L
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 2252
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2252
Mailing Address - Country:US
Mailing Address - Phone:760-835-5380
Mailing Address - Fax:
Practice Address - Street 1:1901 W LUGONIA AVE
Practice Address - Street 2:STE 230
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-9703
Practice Address - Country:US
Practice Address - Phone:909-557-1600
Practice Address - Fax:909-557-1732
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist