Healthcare Provider Details
I. General information
NPI: 1225330467
Provider Name (Legal Business Name): RYAN K BAKER-BARRETT BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/19/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9051 MIRA MESA BLVD # 910385
SAN DIEGO CA
92126-2758
US
IV. Provider business mailing address
9051 MIRA MESA BLVD # 910385
SAN DIEGO CA
92126-2758
US
V. Phone/Fax
- Phone: 619-367-6445
- Fax:
- Phone: 619-367-6445
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | LABA2370 |
| License Number State | MA |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | 1-12-12588 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: