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General NPI Number Information
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NPI Number | 1447360813
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Entity Type | Individual
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Provider Name | MATTHEW DOUGLAS BAUER L.AC.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 2186 3RD ST
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City | LA VERNE
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State | CA
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Zip | 91750-4901
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Country | US
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Telephone | 909-599-2347
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Fax | 909-392-8608
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Provider Business Mailing Address
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Address Line | 3827 EMERALD AVE
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City | LA VERNE
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State | CA
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Zip | 91750-2904
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Country | US
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Telephone | 909-599-2347
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Fax | 909-392-8608
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC2668
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License Number State | CA
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