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NPI Code Detail

MEDICARE: GABRIEL BACH LMFT

MEDICARE: GABRIEL BACH LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist134858CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1134858OTHERCABOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number : 1124605191
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL BACH LMFT
Provider Business Mailing Address
First Line : 1990 S BUNDY DR STE 320
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-5249
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1990 S BUNDY DR STE 320
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-5249
Country : US
Telephone Number : 310-990-0988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 09/30/2022

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