Healthcare Provider Details

I. General information

NPI: 1154332039
Provider Name (Legal Business Name): GREGORY BAIMA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP
SAN ANTONIO TX
78236-5638
US

IV. Provider business mailing address

1618 TRUEMPER ST RM 119
SAN ANTONIO TX
78236-5511
US

V. Phone/Fax

Practice location:
  • Phone: 210-671-4490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001308
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number37135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: