Healthcare Provider Details

I. General information

NPI: 1922437961
Provider Name (Legal Business Name): HAROLD BALDWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S VERMONT AVE
LOS ANGELES CA
90037-3527
US

IV. Provider business mailing address

5201 W. VERMONT
LOS ANGELES CA
90037
US

V. Phone/Fax

Practice location:
  • Phone: 323-751-2677
  • Fax:
Mailing address:
  • Phone: 323-751-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: