1750382925 NPI number — MARK ALLEN BAKER D.P.T., O.C.S.

Table of content: MARK ALLEN BAKER D.P.T., O.C.S. (NPI 1750382925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750382925 NPI number — MARK ALLEN BAKER D.P.T., O.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
MARK
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T., O.C.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1750382925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-305-1383
Provider Business Mailing Address Fax Number:
909-305-1435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 W CYPRESS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIMAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91773-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-305-1383
Provider Business Practice Location Address Fax Number:
909-305-1435
Provider Enumeration Date:
08/09/2005

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: 225100000X , with the licence number:  PT 14488 , 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: 094711 . This is a "HEALTHNET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 21123014675 . This is a "BEECHSTREET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 827415 . This is a "FIRST HEALTH AND CCN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PP3950 . This is a "SAN GABRIEL REGIONAL CENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ01897Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004140895 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 912124601 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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