Healthcare Provider Details

I. General information

NPI: 1891948196
Provider Name (Legal Business Name): NOLI CANTUBA BALDEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SETON PKWY
ROUND ROCK TX
78665-8000
US

IV. Provider business mailing address

1401 MEDICAL PKWY BUILDING B, SUITE 220
CEDAR PARK TX
78613-7763
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-5114
  • Fax: 713-790-6615
Mailing address:
  • Phone: 512-324-4083
  • Fax: 512-324-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP4285
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: