Provider Demographics
NPI:1578335063
Name:BAKER, MARIAH (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S BROOKHURST ST UNIT 2011
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5458
Mailing Address - Country:US
Mailing Address - Phone:714-902-9306
Mailing Address - Fax:
Practice Address - Street 1:1334 BISON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-9071
Practice Address - Country:US
Practice Address - Phone:714-902-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty