Healthcare Provider Details

I. General information

NPI: 1871940478
Provider Name (Legal Business Name): OLIVIA BAKER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 PARK AVE
SOQUEL CA
95073-2821
US

IV. Provider business mailing address

2955 PARK AVE
SOQUEL CA
95073-2821
US

V. Phone/Fax

Practice location:
  • Phone: 831-257-0339
  • Fax: 831-257-0407
Mailing address:
  • Phone: 831-257-0339
  • Fax: 831-257-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: