Healthcare Provider Details

I. General information

NPI: 1376468801
Provider Name (Legal Business Name): CORTEZ AMILEON BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2624
US

IV. Provider business mailing address

382 NE 191ST ST STE 98090
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 651-431-6628
  • Fax:
Mailing address:
  • Phone: 651-431-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: