| Doctor Name: | NICOLE CORY BALTRUSHES |
| NPI Number: | 1740546589 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 3569 Round Barn Cir Ste 200 Santa Rosa, CA - 954035781 |
| Business Phone Number: | 7075838800 |
| Business Fax Number: | 7075838808 |
| Mailing Address: | 2500 Costa Regional Medical Center, Contra Costa Regional Medical Center MARTINEZ |
| State: | CA |
| Postal Code: | 94553 |
| Phone Number: | 9253705646 |
| Fax Number: | 9253705142 |
| NPI Enumeration Date: | 04/05/2012 |
| NPI Last Update Date: | 10/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |