Healthcare Provider Details

I. General information

NPI: 1316254659
Provider Name (Legal Business Name): CAPPIE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 BONITA ST SUITE X
CARSON CA
90746-3680
US

IV. Provider business mailing address

20930 BONITA ST SUITE X
CARSON CA
90746-3680
US

V. Phone/Fax

Practice location:
  • Phone: 310-523-2161
  • Fax:
Mailing address:
  • Phone: 310-523-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number32531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: