Healthcare Provider Details

I. General information

NPI: 1699444117
Provider Name (Legal Business Name): BAO HER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W VERMONT AVE STE 104
ESCONDIDO CA
92025-6584
US

IV. Provider business mailing address

9465 FARNHAM ST
SAN DIEGO CA
92123-1308
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-9884
  • Fax: 760-432-9953
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number245861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: