Healthcare Provider Details

I. General information

NPI: 1477955441
Provider Name (Legal Business Name): ANDREW BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 SPYRES WAY BLDG. B STE 7
MODESTO CA
95356-9800
US

IV. Provider business mailing address

800 SCENIC DR STE A
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: