Healthcare Provider Details

I. General information

NPI: 1699067272
Provider Name (Legal Business Name): CARLOS ANTONIO BALDIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E THOMAS RD
PHOENIX AZ
85014-5707
US

IV. Provider business mailing address

1311 E THOMAS RD
PHOENIX AZ
85014-5707
US

V. Phone/Fax

Practice location:
  • Phone: 602-322-1315
  • Fax: 602-322-1316
Mailing address:
  • Phone: 602-322-1315
  • Fax: 602-322-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44502
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: