1386747996 NPI number — MS. PATRICIA JANE BAKER MARRIAGE & FAMILY TH

Table of content: MS. PATRICIA JANE BAKER MARRIAGE & FAMILY TH (NPI 1386747996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386747996 NPI number — MS. PATRICIA JANE BAKER MARRIAGE & FAMILY TH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
PATRICIA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MARRIAGE & FAMILY TH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
LUTHER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MARRIAGE & FAMILY TH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386747996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20833 STEVENS CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CUPERTINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-873-1592
Provider Business Mailing Address Fax Number:
408-342-0617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20833 STEVENS CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CUPERTINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-873-1592
Provider Business Practice Location Address Fax Number:
408-342-0617
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC14464 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ8712Z . This is a "BLUE SHIELD BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ID067117 . This is a "MENTAL HEALTH NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com