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NPI Code Detail

MEDICARE: ANTHONY JACOB BACA JR.

MEDICARE: ANTHONY JACOB BACA JR.
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1720398159
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY JACOB BACA JR.
Provider Business Mailing Address
First Line : 5105 SMOKE RANCH RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-3536
Country : US
Telephone Number : 702-638-0395
Fax Number : 702-638-0362
Provider Business Practice Location Address
First Line : 5105 SMOKE RANCH RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-3536
Country : US
Telephone Number : 702-638-0395
Fax Number : 702-638-0362
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2010
Last Update Date : 10/19/2010

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Directions to “ ANTHONY JACOB BACA JR. ” Practice Location

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