Provider Demographics
NPI:1639319452
Name:BAKER, GARY ANTHONY II
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANTHONY
Last Name:BAKER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5515
Mailing Address - Country:US
Mailing Address - Phone:619-477-0757
Mailing Address - Fax:619-477-0799
Practice Address - Street 1:1840 WILSON AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5515
Practice Address - Country:US
Practice Address - Phone:619-477-0757
Practice Address - Fax:619-477-0799
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health