Provider Demographics
NPI:1508081837
Name:BAUMAN, NOEL JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:JAMES
Last Name:BAUMAN
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 1:2800 OLYMPIC PKWY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-6007
Mailing Address - Country:US
Mailing Address - Phone:619-482-2085
Mailing Address - Fax:619-482-6168
Practice Address - Street 1:2800 OLYMPIC PKWY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-6007
Practice Address - Country:US
Practice Address - Phone:619-482-2085
Practice Address - Fax:619-482-6168
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20675103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports