Provider Demographics
NPI:1043650724
Name:BAKER, EBONY M
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EBONY
Other - Middle Name:M
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16611 QUAIL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5305
Mailing Address - Country:US
Mailing Address - Phone:281-573-7247
Mailing Address - Fax:
Practice Address - Street 1:1172 3RD AVE
Practice Address - Street 2:STE D-1
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3116
Practice Address - Country:US
Practice Address - Phone:619-691-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No374U00000XNursing Service Related ProvidersHome Health Aide