Individual
COREY THOMAS BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5205 CASCABEL RD, ATASCADERO, CA 93422-2316
(805) 439-4890
Mailing address
2945 MCMILLAN AVE STE 240, SAN LUIS OBISPO, CA 93401-6771
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41105
CA
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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