Healthcare Provider Details

I. General information

NPI: 1013105501
Provider Name (Legal Business Name): CATHERINE L BAKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE L CLARK ARNP

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 E ATHERTON ST
LONG BEACH CA
90815
US

IV. Provider business mailing address

1007 MARYLAND DR
VISTA CA
92083-3338
US

V. Phone/Fax

Practice location:
  • Phone: 562-961-0155
  • Fax: 562-961-0161
Mailing address:
  • Phone: 253-208-9448
  • Fax: 760-659-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30007898
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: