Provider Demographics
NPI:1134149743
Name:BAKER-FORTINER, CLAUDIA ALISE (MPT)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:ALISE
Last Name:BAKER-FORTINER
Suffix:
Gender:F
Credentials:MPT
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 2069
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2069
Mailing Address - Country:US
Mailing Address - Phone:760-767-3561
Mailing Address - Fax:760-767-3571
Practice Address - Street 1:590 PALM CANYON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-2069
Practice Address - Country:US
Practice Address - Phone:760-767-3661
Practice Address - Fax:760-767-3571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ06891Medicare UPIN
DF8709Medicare PIN
CAWPT29205AMedicare PIN