Healthcare Provider Details

I. General information

NPI: 1720869332
Provider Name (Legal Business Name): MICHELLE BAKER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WINTON DR
CONCORD CA
94518-3598
US

IV. Provider business mailing address

6462 BAYVIEW DR
OAKLAND CA
94605-3134
US

V. Phone/Fax

Practice location:
  • Phone: 925-686-5353
  • Fax:
Mailing address:
  • Phone: 954-557-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number070102003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: