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General NPI Number Information
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NPI Number | 1255612305
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Entity Type | Individual
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Provider Name | MR. CHARLES BAUMAN
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Gender | Male
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 6529 CROWN BLVD STE D
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City | SAN JOSE
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State | CA
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Zip | 95120-2905
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Country | US
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Telephone | 831-431-0346
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Fax |
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Provider Business Mailing Address
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Address Line | 219 VAN NESS AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3535
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Country | US
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Telephone | 831-431-0346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 49830
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License Number State | CA
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