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NPI Code Detail

MEDICARE: LARRY BAKER PA

MEDICARE: LARRY BAKER PA
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
1363A00000XPhysician AssistantPA12823CA

General Provider Information

NPI Number : 1689673709
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY BAKER PA
Provider Business Mailing Address
First Line : 1500 EXPO PKWY
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4227
Country : US
Telephone Number : 916-646-8300
Fax Number : 916-920-4434
Provider Business Practice Location Address
First Line : 4001 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95819-3626
Country : US
Telephone Number : 916-453-4528
Fax Number : 916-456-5267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 07/08/2007

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Directions to “ LARRY BAKER PA” Practice Location

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