Provider Demographics
NPI:1174652507
Name:BALDONADO, JOHN PATRICK (LADAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:BALDONADO
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4202
Mailing Address - Country:US
Mailing Address - Phone:575-437-2453
Mailing Address - Fax:575-443-1504
Practice Address - Street 1:1601 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5046
Practice Address - Country:US
Practice Address - Phone:575-437-2453
Practice Address - Fax:575-443-1504
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4745101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)