Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME134252 | FL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME134252 | FL |
NPI | 1225422074 |
---|---|
Provider Name | Valeria Cristina Baldivieso |
First Address | Winter Park, FL 32789-4679 |
Second Address | Winter Park, FL 32789-4679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2015 |
Last Update Date | 03/11/2021 |