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General NPI Number Information
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NPI Number | 1265707764
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Entity Type | Individual
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Provider Name | MARIA DONNA BALTAZAR MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 501 S BEACH BLVD
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City | ANAHEIM
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State | CA
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Zip | 92804-1810
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Country | US
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Telephone | 714-816-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 1780 W LINCOLN AVE APT 333
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City | ANAHEIM
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State | CA
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Zip | 92801-6760
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Country | US
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Telephone | 562-455-5688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | OT 10247
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT 10247
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License Number State | CA
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