Healthcare Provider Details

I. General information

NPI: 1962529776
Provider Name (Legal Business Name): RACHEL FENNING BAKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL MAY FENNING PH.D.

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RED HILL AVE SUITE 100
SANTA ANA CA
92705-5518
US

IV. Provider business mailing address

800 N STATE COLLEGE BLVD EC 572
FULLERTON CA
92831-3547
US

V. Phone/Fax

Practice location:
  • Phone: 949-267-0400
  • Fax:
Mailing address:
  • Phone: 657-278-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: