Healthcare Provider Details

I. General information

NPI: 1427417146
Provider Name (Legal Business Name): LOUISE ELIZABETH BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 W WHITMORE AVE
MODESTO CA
95358-9452
US

IV. Provider business mailing address

1629 W WHITMORE AVE
MODESTO CA
95358-9452
US

V. Phone/Fax

Practice location:
  • Phone: 209-537-5221
  • Fax: 209-531-0233
Mailing address:
  • Phone: 209-537-5221
  • Fax: 209-531-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: