MEDICARE: DR. MATTHEW RYAN BAITY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	22917	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	W06340	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1013981505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RYAN BAITY PHD

Provider Business Mailing Address
First Line	:	2030 W EL CAMINO AVE
Second Line	:	ALLIANT INTERNATIONAL UNIVERSITY
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1866
Country	:	US
Telephone Number	:	510-274-8567
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 W EL CAMINO AVE
Second Line	:	ALLIANT INTERNATIONAL UNIVERSITY
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1866
Country	:	US
Telephone Number	:	510-274-8567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/22/2016

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