Healthcare Provider Details

I. General information

NPI: 1558776971
Provider Name (Legal Business Name): SHIRLEY LEE BAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR. ATL 2084 STE 308 ZONA RIO
TIJUANA BC
22010
MX

IV. Provider business mailing address

4492 CAMINO DE LA PLZ STE 26
SAN YSIDRO CA
92173-3071
US

V. Phone/Fax

Practice location:
  • Phone: 619-270-2165
  • Fax:
Mailing address:
  • Phone: 619-971-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberCEDULA 4680157
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: