Provider Demographics
NPI:1427098417
Name:MARTINEZ-BAKER, TERESA JESSIE (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JESSIE
Last Name:MARTINEZ-BAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518A N H ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5324
Mailing Address - Country:US
Mailing Address - Phone:805-740-0161
Mailing Address - Fax:805-740-0136
Practice Address - Street 1:518A N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5324
Practice Address - Country:US
Practice Address - Phone:805-740-0161
Practice Address - Fax:805-740-0136
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04920Medicare UPIN
CAWDC29693Medicare ID - Type Unspecified