Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 29098 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 29098 | CA |
NPI | 1013076918 |
---|---|
Provider Name | Miss Carrie Lynn Baker |
First Address | San Diego, CA 92110 |
Second Address | San Diego, CA 92110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 13/04/2017 |