Provider Demographics
NPI:1760620983
Name:BAETA, LOIS CORINA (NP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:CORINA
Last Name:BAETA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 LOW CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9771
Mailing Address - Country:US
Mailing Address - Phone:707-428-2731
Mailing Address - Fax:707-428-2740
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2580
Practice Address - Country:US
Practice Address - Phone:707-427-4900
Practice Address - Fax:707-551-3617
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN650838163W00000X
CANP17099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse