Healthcare Provider Details

I. General information

NPI: 1093821639
Provider Name (Legal Business Name): ROBERT ARNOLD BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 WASHINGTON PL
SAN DIEGO CA
92103-2723
US

IV. Provider business mailing address

1820 WASHINGTON PL
SAN DIEGO CA
92103-2723
US

V. Phone/Fax

Practice location:
  • Phone: 949-259-0463
  • Fax: 949-259-0463
Mailing address:
  • Phone: 949-259-0463
  • Fax: 949-259-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG041345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: