Healthcare Provider Details

I. General information

NPI: 1982910485
Provider Name (Legal Business Name): DENINE A. BALDOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENINE A GOLLAHON NP

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WEBSTER ST STE 612
OAKLAND CA
94609-3101
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95005536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: