Healthcare Provider Details

I. General information

NPI: 1972079663
Provider Name (Legal Business Name): ROBERT RICHARD BAUER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PESETAS LN
SANTA BARBARA CA
93110-1416
US

IV. Provider business mailing address

173 BUCKNELL AVE
VENTURA CA
93003-3919
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-6110
  • Fax:
Mailing address:
  • Phone: 805-341-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95009961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: