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NPI Code Detail

MEDICARE: MINAH BAEK RN

MEDICARE: MINAH BAEK RN
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
1163WP2201XAmbulatory Care Registered Nurse703320CA

General Provider Information

NPI Number : 1760143895
Entity Type Code : Individual
Provider Name (Legal Business Name) : MINAH BAEK RN
Provider Business Mailing Address
First Line : 10569 ENGLEWOOD DR
Second Line :
City : OAKLAND
State : CA
Zip : 94605-5013
Country : US
Telephone Number : 707-567-7320
Fax Number :
Provider Business Practice Location Address
First Line : 1411 E 31ST ST
Second Line :
City : OAKLAND
State : CA
Zip : 94602-1092
Country : US
Telephone Number : 510-437-6463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2021
Last Update Date : 12/30/2021

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