Healthcare Provider Details

I. General information

NPI: 1710392089
Provider Name (Legal Business Name): PALOMA BAKER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 S CENTINELA AVE
CULVER CITY CA
90230-6301
US

IV. Provider business mailing address

480 ROSECRANS AVE APT 4
MANHATTAN BEACH CA
90266-3464
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax:
Mailing address:
  • Phone: 818-399-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: