Healthcare Provider Details

I. General information

NPI: 1013616853
Provider Name (Legal Business Name): THE BAUMAN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 MARSH ST
SAN LUIS OBISPO CA
93401-3316
US

IV. Provider business mailing address

1368 MARSH ST
SAN LUIS OBISPO CA
93401-3316
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-7060
  • Fax: 805-540-7063
Mailing address:
  • Phone: 805-540-7060
  • Fax: 805-540-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA ROBERTS
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-235-8653