Healthcare Provider Details

I. General information

NPI: 1518884121
Provider Name (Legal Business Name): BRENDA BALTODANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HOLMES ST
KANSAS CITY MO
64108-2602
US

IV. Provider business mailing address

2996 OAK ST APT 101
KANSAS CITY MO
64108-3390
US

V. Phone/Fax

Practice location:
  • Phone: 816-218-2500
  • Fax:
Mailing address:
  • Phone: 816-204-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2026020928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: