MEDICARE: MR. ROBERT WAYNE BAKER N.P.

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	363LP2300X	Primary Care Nurse Practitioner	95012875	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95012875	CA

General Provider Information

NPI Number	:	1689225427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT WAYNE BAKER N.P.

Provider Business Mailing Address
First Line	:	1711 W TEMPLE ST STE 1082
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7329
Country	:	US
Telephone Number	:	818-395-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 W TEMPLE ST STE 1082
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7329
Country	:	US
Telephone Number	:	818-395-3060
Fax Number	:

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

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	11/06/2023

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