=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215006143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALDIS BALTINS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 08/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1165 S DORA ST SUITE C1
-----------------------------------------------------
City | UKIAH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-468-0471
-----------------------------------------------------
Fax | 707-468-1182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1165 S DORA ST SUITE C1
-----------------------------------------------------
City | UKIAH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-468-0471
-----------------------------------------------------
Fax | 707-468-1182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | DR. ALDIS BALTINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 707-468-0471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------