Healthcare Provider Details

I. General information

NPI: 1073783114
Provider Name (Legal Business Name): EDUARD BALDO UBALDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 SAMOS WAY
SACRAMENTO CA
95823-4029
US

IV. Provider business mailing address

3820 SAMOS WAY
SACRAMENTO CA
95823-4029
US

V. Phone/Fax

Practice location:
  • Phone: 916-427-3356
  • Fax:
Mailing address:
  • Phone: 916-427-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberB7552782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: