Healthcare Provider Details

I. General information

NPI: 1740630508
Provider Name (Legal Business Name): PAMELA LIEBENTHAL BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 309
TARZANA CA
91356-6145
US

IV. Provider business mailing address

5525 ETIWANDA AVE STE 309
TARZANA CA
91356-6145
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-3200
  • Fax: 818-345-3254
Mailing address:
  • Phone: 818-345-3200
  • Fax: 818-345-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD8104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: