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NPI Code Detail

MEDICARE: VANESSA DIANE BARACALDO

MEDICARE: VANESSA DIANE BARACALDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician289397NY

General Provider Information

NPI Number : 1447678388
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA DIANE BARACALDO
Provider Business Mailing Address
First Line : 3332 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10031-8732
Country : US
Telephone Number : 212-694-2000
Fax Number :
Provider Business Practice Location Address
First Line : 3332 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10031-8732
Country : US
Telephone Number : 212-694-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2014
Last Update Date : 01/25/2021

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Directions to “ VANESSA DIANE BARACALDO ” Practice Location

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