Healthcare Provider Details

I. General information

NPI: 1619519691
Provider Name (Legal Business Name): VANESSA BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5828 STONERIDGE MALL ROAD SUIT 205
PLEASANTON CA
94588
US

IV. Provider business mailing address

5828 STONERIDGE MALL ROAD SUIT 205
PLEASANTON CA
94588
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax: 866-500-2168
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: