Provider Demographics
NPI:1588461560
Name:BAKER, GEOFFREY (MBA)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:BAKER
Suffix:
Gender:
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 PALO DURO AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3839
Mailing Address - Country:US
Mailing Address - Phone:505-920-3337
Mailing Address - Fax:
Practice Address - Street 1:4004 CARLISLE BLVD NE STE C3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4565
Practice Address - Country:US
Practice Address - Phone:505-226-3042
Practice Address - Fax:505-441-2845
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker