Individual
MR. RUSSELL THOMAS BAKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, MS, ATC
Contact information
Practice address
8432 MAGNOLIA AVE, RIVERSIDE, CA 92504-3206
(239) 560-7854
Mailing address
7450 NORTHROP DR APT 94, RIVERSIDE, CA 92508-5005
(239) 560-7854
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/09/2007
Last updated
12/02/2009
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