Provider Demographics
NPI:1982000717
Name:BAISA, CLARIBEL
Entity Type:Individual
Prefix:
First Name:CLARIBEL
Middle Name:
Last Name:BAISA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARIBEL
Other - Middle Name:
Other - Last Name:BAISA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:15921 VIA CONEJO
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2338
Mailing Address - Country:US
Mailing Address - Phone:510-590-0434
Mailing Address - Fax:
Practice Address - Street 1:2608 CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3148
Practice Address - Country:US
Practice Address - Phone:510-675-0600
Practice Address - Fax:510-675-0185
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical