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General NPI Number Information
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NPI Number | 1851743827
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Entity Type | Individual
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Provider Name | BRUCE CALVIN UNDERWOOD DR.P.H.,M.S.E.,M.P.H
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Gender | Male
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 75895 ALTAMIRA DR
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City | INDIAN WELLS
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State | CA
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Zip | 92210-8768
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Country | US
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Telephone | 760-238-1446
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Fax | 760-773-9706
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Provider Business Mailing Address
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Address Line | 75895 ALTAMIRA DR
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City | INDIAN WELLS
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State | CA
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Zip | 92210-8768
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Country | US
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Telephone | 760-238-1446
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Fax | 760-773-9706
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | CA
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