Healthcare Provider Details

I. General information

NPI: 1801957022
Provider Name (Legal Business Name): PHILLIP BARNEY BALDI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CREEKSIDE DR STE 1300
FOLSOM CA
95630-3444
US

IV. Provider business mailing address

1600 CREEKSIDE DRIVE STE 1300
FOLSOM CA
95630
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-7880
  • Fax: 916-983-8588
Mailing address:
  • Phone: 916-984-7880
  • Fax: 916-983-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA4854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: