Healthcare Provider Details

I. General information

NPI: 1194658906
Provider Name (Legal Business Name): NICHOLAS A BALDERAS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 NORWALK BLVD
SANTA FE SPRINGS CA
90670-6946
US

IV. Provider business mailing address

9760 JERSEY AVE APT 164
SANTA FE SPRINGS CA
90670-3164
US

V. Phone/Fax

Practice location:
  • Phone: 562-968-1300
  • Fax:
Mailing address:
  • Phone: 562-587-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: