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
1	225C00000X	Rehabilitation 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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