Provider Demographics
NPI:1013907377
Name:BAKER, MARNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:
Last Name:BAKER
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 1:4050 BARRANCA PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4785
Mailing Address - Country:US
Mailing Address - Phone:949-551-1090
Mailing Address - Fax:949-262-5500
Practice Address - Street 1:4050 BARRANCA PKWY STE 170
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4785
Practice Address - Country:US
Practice Address - Phone:949-551-1090
Practice Address - Fax:949-262-5500
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77478208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A77478Medicaid
CAH89300Medicare UPIN
CACZ970YMedicare PIN
CAWA77478AMedicare PIN