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General NPI Number Information
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NPI Number | 1760410054
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Entity Type | Individual
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Provider Name | JOLENE ELIZABETH BAKER MA, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ATHLETIC DEPARTMENT 3601 PACIFIC AVE.
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City | STOCKTON
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State | CA
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Zip | 95211-0001
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Country | US
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Telephone | 209-946-2588
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Fax |
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Provider Business Mailing Address
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Address Line | 6610 N. EMBARCADERO, #5
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City | STOCKTON
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State | CA
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Zip | 95219
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Country | US
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Telephone | 209-946-2588
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Fax | 209-946-2190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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