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NPI Code Detail

MEDICARE: MR. HERBERT RAY BUMGART JR.

MEDICARE:  MR. HERBERT RAY BUMGART JR.
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
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1336289818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HERBERT RAY BUMGART JR.
Provider Business Mailing Address
First Line : 1295 STATE ST SUITE 106
Second Line :
City : EL CENTRO
State : CA
Zip : 92251
Country : US
Telephone Number : 760-336-8534
Fax Number : 760-337-7885
Provider Business Practice Location Address
First Line : 1295 STATE ST SUITE 106
Second Line :
City : EL CENTRO
State : CA
Zip : 92251
Country : US
Telephone Number : 760-336-8534
Fax Number : 760-337-7885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/08/2007

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Directions to “ MR. HERBERT RAY BUMGART JR. ” Practice Location

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