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NPI Code Detail

MEDICARE: MS. INGRID SORAIDA BALTZER BAUER LCSW

MEDICARE: MS. INGRID SORAIDA BALTZER BAUER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker053845NY
21041C0700XClinical Social Worker45152CA

General Provider Information

NPI Number : 1497712202
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. INGRID SORAIDA BALTZER BAUER LCSW
Provider Business Mailing Address
First Line : 333 S BEAUDRY AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-1466
Country : US
Telephone Number : 213-241-3305
Fax Number :
Provider Business Practice Location Address
First Line : 333 S BEAUDRY AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-1466
Country : US
Telephone Number : 213-241-3305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 08/03/2020

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Directions to “ MS. INGRID SORAIDA BALTZER BAUER LCSW” Practice Location

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