Provider Demographics
NPI:1124877915
Name:BALDIVIA, ASIA CORRINE
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:CORRINE
Last Name:BALDIVIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-6034
Mailing Address - Country:US
Mailing Address - Phone:307-343-6366
Mailing Address - Fax:
Practice Address - Street 1:1677 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-6034
Practice Address - Country:US
Practice Address - Phone:307-343-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator