Provider Demographics
NPI:1790577260
Name:BALDERAS, JOVITA MARIA
Entity type:Individual
Prefix:
First Name:JOVITA
Middle Name:MARIA
Last Name:BALDERAS
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 1:811 SE SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4666
Mailing Address - Country:US
Mailing Address - Phone:971-225-9527
Mailing Address - Fax:
Practice Address - Street 1:811 SE SHERMAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4666
Practice Address - Country:US
Practice Address - Phone:971-225-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIN-10249359106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician