MEDICARE: GARY ANGELO BAFFA PHD, M.S

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	PSY8143	CA

General Provider Information

NPI Number	:	1275604001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY ANGELO BAFFA PHD, M.S

Provider Business Mailing Address
First Line	:	PO BOX 544
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92822-0544
Country	:	US
Telephone Number	:	714-672-9338
Fax Number	:	714-255-1440

Provider Business Practice Location Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	SUITE # 900
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-687-5150
Fax Number	:	714-626-0016

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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