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NPI Code Detail

MEDICARE: TIMOTHY BAKER 103T00000X

MEDICARE: TIMOTHY BAKER 103T00000X
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
1103T00000XPsychologistCA

General Provider Information

NPI Number : 1588525737
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY BAKER 103T00000X
Provider Business Mailing Address
First Line : 5832 BOLSA AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92649-1181
Country : US
Telephone Number : 714-903-7000
Fax Number :
Provider Business Practice Location Address
First Line : 5832 BOLSA AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92649-1181
Country : US
Telephone Number : 714-903-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2025
Last Update Date : 11/18/2025

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