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NPI Code Detail

MEDICARE: TANYA E. BAKER NP

MEDICARE: TANYA E. BAKER NP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerNP95004209CA

General Provider Information

NPI Number : 1699184259
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA E. BAKER NP
Provider Business Mailing Address
First Line : 4510 EXECUTIVE DR STE 315
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3029
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4510 EXECUTIVE DR STE 315
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3029
Country : US
Telephone Number : 858-534-8019
Fax Number : 858-534-6727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2014
Last Update Date : 01/23/2020

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