1548325731 NPI number — CLAUDIA BAKER-FORTINER, PT

Table of content: (NPI 1548325731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548325731 NPI number — CLAUDIA BAKER-FORTINER, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAUDIA BAKER-FORTINER, PT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548325731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2069
Provider Second Line Business Mailing Address:
590- PALM CANYON DRIVE, #203.
Provider Business Mailing Address City Name:
BORREGO SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92004-2069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-767-3561
Provider Business Mailing Address Fax Number:
760-767-3571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 PALM CANYON DRIVE
Provider Second Line Business Practice Location Address:
SUITE #203.
Provider Business Practice Location Address City Name:
BORREGO SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92004-2069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-767-3561
Provider Business Practice Location Address Fax Number:
760-767-3571
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER-FORTINER
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
760-767-3561

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT29205 , 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)





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