Provider Demographics
NPI:1306207725
Name:BAKER, CLINTRICIA
Entity Type:Individual
Prefix:
First Name:CLINTRICIA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
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 153107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75315-3107
Mailing Address - Country:US
Mailing Address - Phone:214-915-9936
Mailing Address - Fax:972-587-7105
Practice Address - Street 1:4907 SPRING AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1360
Practice Address - Country:US
Practice Address - Phone:972-370-6773
Practice Address - Fax:972-587-7105
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health