Healthcare Provider Details

I. General information

NPI: 1447383070
Provider Name (Legal Business Name): ROBERT RYAN BALDWIN CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 SPRING ST
PLACERVILLE CA
95667-4543
US

IV. Provider business mailing address

768 PLEASANT VALLEY RD STE 201
DIAMOND SPRINGS CA
95619-9260
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6667
  • Fax:
Mailing address:
  • Phone: 530-621-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII5251214
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberAII5251214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: