Jacqueline Baltazar

Primary specialty

Social WorkerTaxonomy code 104100000X

License

106661 Issued in CA

Practice address

572 N Arrowhead Ave Ste 100
San Bernardino, CA 92401-1217

Phone

(626) 776-4593

NPI assigned

May 15, 2024

Last updated

May 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jackie Baltazar Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1558110148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 N ARROWHEAD AVE STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 N ARROWHEAD AVE STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011217",
            "telephone_number": "626-776-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALTAZAR",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "106661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "BALTAZAR",
            "credential": "MSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Nicole Elizabeth Baldonado
• Jeffrey Manuel Balencia, MD
• Benjamin Stephen Balisky
• Mykalanne Ball, M.S.
• Renee Ballesteros
• John Kenneth Baltazar II
• Samantha Baltazar, PA
• Viviana Baltazar
• Yessica Baltazar
• Daisy Priscilla Banales

• Social Worker in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.