Individual
GERARDO BALTIERRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13177 RAMONA BLVD, BALDWIN PARK, CA 91706-3855
(626) 337-3828
Mailing address
4319 HARLAN AVE, BALDWIN PARK, CA 91706-2857
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
98534377E47284
—
CA
01
—
D8491732
DRIVER'S LICENSE
CA
Enumeration date
11/26/2018
Last updated
11/26/2018
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