1902098304 NPI number — GARY L BAKER MD A PROFESSIONAL CORPORATION

Table of content: (NPI 1902098304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902098304 NPI number — GARY L BAKER MD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY L BAKER MD A PROFESSIONAL CORPORATION
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:
1902098304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750 DOWNEY AVE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90712-1480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-408-4636
Provider Business Mailing Address Fax Number:
562-408-2684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 DOWNEY AVE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-408-4636
Provider Business Practice Location Address Fax Number:
562-408-2684
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
LAMONT
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
562-408-4636

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W19147 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DO480A . This is a "OTHER MEDICARE GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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