Healthcare Provider Details

I. General information

NPI: 1740629310
Provider Name (Legal Business Name): JEFFREY JAMES BAUMANN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-660 KAMEHAMEHA HWY
KAHUKU HI
96731-2210
US

IV. Provider business mailing address

53-017 POKIWAI PL
HAUULA HI
96717-9728
US

V. Phone/Fax

Practice location:
  • Phone: 231-459-6177
  • Fax:
Mailing address:
  • Phone: 231-459-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: