Provider Demographics
NPI:1275604001
Name:BAFFA, GARY ANGELO (PHD, MS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANGELO
Last Name:BAFFA
Suffix:
Gender:M
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-0544
Mailing Address - Country:US
Mailing Address - Phone:714-672-9338
Mailing Address - Fax:714-255-1440
Practice Address - Street 1:1440 N HARBOR BLVD
Practice Address - Street 2:SUITE # 900
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4127
Practice Address - Country:US
Practice Address - Phone:714-687-5150
Practice Address - Fax:714-626-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8143AMedicare ID - Type Unspecified