Healthcare Provider Details

I. General information

NPI: 1518340751
Provider Name (Legal Business Name): JEANETTE BALDONADO BOTWIN RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 10/15/2024
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

4440 BROCKTON AVE STE 420
RIVERSIDE CA
92501-4026
US

V. Phone/Fax

Practice location:
  • Phone: 888-770-2462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95004133
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number6894281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: