Provider Demographics
NPI:1205928140
Name:BAQUET, RENE PHILIPPE (PA)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:PHILIPPE
Last Name:BAQUET
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:CA
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-0841
Mailing Address - Country:US
Mailing Address - Phone:626-334-9818
Mailing Address - Fax:775-249-7634
Practice Address - Street 1:223 S MURRAY AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-4610
Practice Address - Country:US
Practice Address - Phone:626-969-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11523363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS42010Medicare UPIN