Provider Demographics
NPI:1700898988
Name:BAICK, DONNA G (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:G
Last Name:BAICK
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 1:29 ALONDRA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1812
Mailing Address - Country:US
Mailing Address - Phone:714-835-0101
Mailing Address - Fax:714-835-1133
Practice Address - Street 1:1140 W LA VETA AVE STE 560
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4214
Practice Address - Country:US
Practice Address - Phone:714-835-0101
Practice Address - Fax:714-835-1133
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH68082Medicare UPIN