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General NPI Number Information
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NPI Number | 1730691742
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Entity Type | Individual
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Provider Name | LARISSA BALDONADO NP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 111 SANDOVAL RD SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-7320
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Country | US
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Telephone | 505-631-0019
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Fax | 505-631-0020
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Provider Business Mailing Address
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Address Line | 1700 TESORO LOOP NW
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City | LOS LUNAS
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State | NM
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Zip | 87031-8963
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Country | US
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Telephone | 505-631-0019
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Fax | 505-631-0020
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 78581
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN-82564
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License Number State | NM
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