Healthcare Provider Details

I. General information

NPI: 1780884072
Provider Name (Legal Business Name): PETRA G BALTIERREZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 S 7TH AVE APMT #33
AVENAL CA
93204-1700
US

IV. Provider business mailing address

1068 S 7TH AVE APMT #33
AVENAL CA
93204-1700
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-9298
  • Fax:
Mailing address:
  • Phone: 559-386-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number512612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: