Healthcare Provider Details

I. General information

NPI: 1013907377
Provider Name (Legal Business Name): MARNIE BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BARRANCA PKWY STE 170
IRVINE CA
92604-4785
US

IV. Provider business mailing address

4050 BARRANCA PKWY STE 170
IRVINE CA
92604-4785
US

V. Phone/Fax

Practice location:
  • Phone: 949-551-1090
  • Fax: 949-262-5500
Mailing address:
  • Phone: 949-551-1090
  • Fax: 949-262-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: