Provider Demographics
NPI:1962230300
Name:BAKER, DAMEION LORENZO
Entity type:Individual
Prefix:MR
First Name:DAMEION
Middle Name:LORENZO
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 VALLEY HILL LN APT 2140
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-8360
Mailing Address - Country:US
Mailing Address - Phone:850-200-7680
Mailing Address - Fax:
Practice Address - Street 1:117 S WATSON RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-2402
Practice Address - Country:US
Practice Address - Phone:469-718-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1807279374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician