Healthcare Provider Details

I. General information

NPI: 1548353329
Provider Name (Legal Business Name): HAROLD EDWARD BAKER IX PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVENUE
TURLOCK CA
95380-2016
US

IV. Provider business mailing address

4301 NORTH STAR WAY
MODESTO CA
95356-9262
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberPA13071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: