Provider Demographics
NPI:1346438819
Name:BALDWIN, HARLAN L (CO)
Entity type:Individual
Prefix:
First Name:HARLAN
Middle Name:L
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24475 SUNNYMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9313
Mailing Address - Country:US
Mailing Address - Phone:951-824-7850
Mailing Address - Fax:951-824-7851
Practice Address - Street 1:24475 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9313
Practice Address - Country:US
Practice Address - Phone:951-824-7850
Practice Address - Fax:951-824-7851
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6685200001Medicare NSC