Provider Demographics
NPI:1861203176
Name:BALDWIN, CHANCE G
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:G
Last Name:BALDWIN
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 1:11951 CHAMBERLAINE WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-2851
Mailing Address - Country:US
Mailing Address - Phone:323-220-3635
Mailing Address - Fax:
Practice Address - Street 1:11951 CHAMBERLAINE WAY APT 2
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-2851
Practice Address - Country:US
Practice Address - Phone:323-220-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE26261893747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider