Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY20518 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20518 | CA |
NPI | 1003976861 |
---|---|
Provider Name | Dr. Kurt Dayne Baker |
First Address | Turlock, CA 95382-0256 |
Second Address | Modesto, CA 95356-8713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |