Provider Demographics
NPI:1053574574
Name:IRORERE, BAULO (RN)
Entity type:Individual
Prefix:MS
First Name:BAULO
Middle Name:
Last Name:IRORERE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BAULO
Other - Middle Name:
Other - Last Name:ANSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2523 EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3305
Mailing Address - Country:US
Mailing Address - Phone:510-215-3700
Mailing Address - Fax:510-215-3770
Practice Address - Street 1:2523 EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3305
Practice Address - Country:US
Practice Address - Phone:510-215-3700
Practice Address - Fax:510-215-3770
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280037163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult