Healthcare Provider Details

I. General information

NPI: 1568009561
Provider Name (Legal Business Name): JONATHON DAVID BAIRD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7265 N 1ST ST STE 103
FRESNO CA
93720-2956
US

IV. Provider business mailing address

13264 E SAGINAW WAY
SANGER CA
93657-9347
US

V. Phone/Fax

Practice location:
  • Phone: 559-492-1560
  • Fax: 559-234-0641
Mailing address:
  • Phone: 559-801-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number31195
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: