Healthcare Provider Details

I. General information

NPI: 1942474143
Provider Name (Legal Business Name): BOBBY VERDUGO M.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 20TH ST
SANTA MONICA CA
90404-2033
US

IV. Provider business mailing address

1339 20TH ST
SANTA MONICA CA
90404-2033
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8032
  • Fax: 310-829-8455
Mailing address:
  • Phone: 310-829-8032
  • Fax: 310-829-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: