MEDICARE: DR. SHIRLEY LEE BAKER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	CEDULA 4680157	ZZ

General Provider Information

NPI Number	:	1558776971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY LEE BAKER DDS

Provider Business Mailing Address
First Line	:	4492 CAMINO DE LA PLZ STE 26
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-3071
Country	:	US
Telephone Number	:	619-971-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	DR. ATL 2084 STE 308
Second Line	:	ZONA RIO
City	:	TIJUANA
State	:	BC
Zip	:	22010
Country	:	MX
Telephone Number	:	619-270-2165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	01/14/2021

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