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NPI Code Detail

MEDICARE: DANICA BAKKER PSY.D

MEDICARE: DANICA BAKKER PSY.D
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
1103T00000XPsychologist
2171M00000XCase Manager/Care Coordinator
3103TC0700XClinical Psychologist27112CA

General Provider Information

NPI Number : 1407189541
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANICA BAKKER PSY.D
Provider Business Mailing Address
First Line : 2101 COURAGE DR
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6717
Country : US
Telephone Number : 707-750-3000
Fax Number :
Provider Business Practice Location Address
First Line : 2100 PEABODY RD
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-6639
Country : US
Telephone Number : 707-451-0182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2009
Last Update Date : 08/19/2022

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