Provider Demographics
NPI:1932650157
Name:BAKER, DONNA (LPT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SANDY HILL CT.
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320
Mailing Address - Country:US
Mailing Address - Phone:909-795-8580
Mailing Address - Fax:
Practice Address - Street 1:116 SANDY HILL CT.
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320
Practice Address - Country:US
Practice Address - Phone:909-795-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30169167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician