Provider Demographics
NPI:1518300557
Name:BALDEO, CANDICE MARINA (MD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARINA
Last Name:BALDEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-1100
Mailing Address - Fax:
Practice Address - Street 1:8TH AVE C STREET
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-2911
Practice Address - Country:US
Practice Address - Phone:801-408-1100
Practice Address - Fax:801-408-4710
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13760163-1205207RH0003X
FLME128719207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology