Provider Demographics
NPI:1093713349
Name:BAUMBACH, H DALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:DALE
Last Name:BAUMBACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2607
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-2607
Mailing Address - Country:US
Mailing Address - Phone:209-728-3020
Mailing Address - Fax:209-728-3020
Practice Address - Street 1:1222 MONACO CT
Practice Address - Street 2:SUITE 13
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6742
Practice Address - Country:US
Practice Address - Phone:209-728-3020
Practice Address - Fax:209-728-3020
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6998103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist