Provider Demographics
NPI:1548325731
Name:CLAUDIA BAKER-FORTINER, PT
Entity type:Organization
Organization Name:CLAUDIA BAKER-FORTINER, PT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER-FORTINER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:760-767-3561
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:590- PALM CANYON DRIVE, #203.
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 DRIVE
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:760-767-3561
Practice Address - Fax:760-767-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29205261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ06891Medicare UPIN
CAW18207Medicare PIN