Healthcare Provider Details

I. General information

NPI: 1679236830
Provider Name (Legal Business Name): CONNOR BAER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E 3RD ST STE A&B
LOS ANGELES CA
90013-1629
US

IV. Provider business mailing address

470 E 3RD ST STE A&B
LOS ANGELES CA
90013-1629
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: