Healthcare Provider Details

I. General information

NPI: 1114991031
Provider Name (Legal Business Name): CARLA D BAKER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 MALL DR STE D
LAS CRUCES NM
88011-8191
US

IV. Provider business mailing address

2720 TOPLEY AVE
LAS CRUCES NM
88005-1334
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-5327
  • Fax:
Mailing address:
  • Phone: 505-522-5327
  • Fax: 505-521-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: