Healthcare Provider Details

I. General information

NPI: 1588931935
Provider Name (Legal Business Name): JOEY BASALDUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE BASALDUA

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 ILFORD RD NE
RIO RANCHO NM
87144-7648
US

IV. Provider business mailing address

2716 FREEDOM BLVD
WATSONVILLE CA
95076-1027
US

V. Phone/Fax

Practice location:
  • Phone: 669-203-7027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-1109
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: