Provider Demographics
NPI:1265703086
Name:BAKER, CHARLES V (MED)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:V
Last Name:BAKER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35303 SW 180TAVE
Mailing Address - Street 2:302
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034
Mailing Address - Country:US
Mailing Address - Phone:786-752-5873
Mailing Address - Fax:
Practice Address - Street 1:35303 SW 180TH AVE
Practice Address - Street 2:302
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-5600
Practice Address - Country:US
Practice Address - Phone:786-752-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker