Provider Demographics
NPI:1386718583
Name:BAKER, BONNIE KAYE (RN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:KAYE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92072
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-2072
Mailing Address - Country:US
Mailing Address - Phone:626-710-3445
Mailing Address - Fax:626-398-1249
Practice Address - Street 1:420 S SAN PEDRO ST STE G3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1938
Practice Address - Country:US
Practice Address - Phone:213-893-5475
Practice Address - Fax:213-299-9992
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334162163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health