Healthcare Provider Details

I. General information

NPI: 1891422929
Provider Name (Legal Business Name): BRANDON BALDWIN PA-CERTIFIED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 CALIFORNIA ST STE A
REDDING CA
96001-1953
US

IV. Provider business mailing address

282 RIDGETOP DR
REDDING CA
96003-3262
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-7070
  • Fax: 530-244-7246
Mailing address:
  • Phone: 530-776-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65240
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP41405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: