Healthcare Provider Details

I. General information

NPI: 1386448827
Provider Name (Legal Business Name): MARK GREGORY BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S AMPHLETT BLVD STE 120
SAN MATEO CA
94402-2711
US

IV. Provider business mailing address

1700 S AMPHLETT BLVD STE 120
SAN MATEO CA
94402-2711
US

V. Phone/Fax

Practice location:
  • Phone: 650-683-2097
  • Fax:
Mailing address:
  • Phone: 650-683-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: