DR. GREGORY K BACA (NPI# 1922171123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922171123 |
| Entity Type | Individual |
| Full Name | DR. GREGORY K BACA |
| Credential | M.D. |
| Practice Address |
464 Central Ave Suite 4 Los Alamos NM 87544-3350 |
| Mailing Address |
112 Grand Canyon Dr Los Alamos NM 87544-3423 |
| Practice Telephone | 5057955217 |
| Practice Fax Number | 5057479696 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2014-01-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
MD2008-0553 | NM | Allopathic & Osteopathic Physicians |
| Street Address |
464 CENTRAL AVE SUITE 4 |
| City | LOS ALAMOS |
| State | NM |
| Zip Code | 87544-3350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457789125 | Greg Baca Md, LLC | Psychiatry & Neurology | 464 Central Ave, Suite 4, Los Alamos, NM 87544-3350 | 2013-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679945935 | Zia Home Health | Home Health | 1475 Central Ave., Suite 125, Los Alamos, NM 87544 | 2015-10-27 |
| 1295131167 | Sara Pocernik | Dietitian, Registered | 1450 Iris Street, Los Alamos, NM 87544 | 2014-11-05 |
| 1760824890 | Lisa Renee Marr Lyon | Psychologist | 3917 West Road, Suite 128, Children's Clinic, P.a., Los Alamos, NM 87544 | 2013-07-17 |
| 1558629725 | Rachel Meyer | Dentist | 112 Central Park Square, Los Alamos, NM 87544 | 2012-04-25 |
| 1902183908 | Susana T. Chavarria | Occupational Therapist | 5 Quemazon Pl., Los Alamos, NM 87544 | 2011-11-04 |
| 1881998664 | Dr. Tom Child and Adolescent Medicine | Pediatrics | Los Alamos Medical Center, 3917 West Rd, Suite M250, Los Alamos, NM 87544 | 2011-01-07 |
| 1952565905 | Dawn Judy Barr | Social Worker | 3 Agila Ct, Los Alamos, NM 87544 | 2008-07-17 |
| 1649452129 | Ellen Vandergust Ballard | Dentist | 111 Longview, Suite B-3, White Rock, NM 87544 | 2007-11-27 |
| 1629290283 | Wildwind Dental | Dentist | 111 Longview Drive, Suite B3, Los Alamos, NM 87544 | 2007-05-03 |
| 1255407342 | Sarah Sue Teasdale | Counselor | 1362 C Trinity Dr, Los Alamos, NM 87544 | 2006-11-28 |
| Find all providers in zip 87544 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770739526 | Edgar Arnold Jones | Psychiatry & Neurology | 2121 Foothills Rd, Santa Fe, NM 87505-4526 | 2008-08-12 |
| 1699948489 | Marcello Argeo Maviglia | Psychiatry & Neurology | 1336 Lafayette Dr Ne, Albuquerque, NM 87106-1123 | 2008-04-11 |
| 1265828214 | Ryan Alexander Mals | Psychiatry & Neurology | 8312 Kaseman Ct Ne, Albuquerque, NM 87110-7639 | 2015-04-07 |
| 1306089313 | Paul E Romo | Psychiatry & Neurology | Msc 09 5030, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2009-04-07 |
| 1578685723 | Bellelizabeth Foster | Psychiatry & Neurology | 1 University of New Mexico, Msc09, Albuquerque, NM 87131-0001 | 2007-04-06 |
| 1922159953 | Claire E Wilcox | Psychiatry & Neurology | 7850 Jefferson St Ne Ste 300, Albuquerque, NM 87109-4314 | 2007-01-16 |
| City | LOS ALAMOS |
| Zip Code | 87544 |
Please comment or provide details below to improve the information on DR. GREGORY K BACA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.