Provider Demographics
NPI:1629142583
Name:BABA, ATSUKO (MD)
Entity Type:Individual
Prefix:DR
First Name:ATSUKO
Middle Name:
Last Name:BABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5402
Mailing Address - Country:US
Mailing Address - Phone:415-884-2042
Mailing Address - Fax:
Practice Address - Street 1:521 PARNASSUS AVE
Practice Address - Street 2:C450 BOX 0648
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2206
Practice Address - Country:US
Practice Address - Phone:415-476-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76550207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A765500Medicaid
CA00A765500Medicaid