Healthcare Provider Details

I. General information

NPI: 1487737847
Provider Name (Legal Business Name): PATRICIA BAINTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C130
LA JOLLA CA
92037-1707
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE C130
LA JOLLA CA
92037-1707
US

V. Phone/Fax

Practice location:
  • Phone: 858-788-2820
  • Fax: 858-788-2822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG86883
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberG86883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: