Provider Demographics
NPI:1770445504
Name:BAKER, JACINDA (CCSS)
Entity type:Individual
Prefix:MS
First Name:JACINDA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1644
Mailing Address - Country:US
Mailing Address - Phone:505-508-3047
Mailing Address - Fax:505-404-0848
Practice Address - Street 1:3655 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1644
Practice Address - Country:US
Practice Address - Phone:505-508-3047
Practice Address - Fax:505-404-0848
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker