Provider Demographics
NPI:1740418508
Name:BAUMAN, DEBORAH M
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WILSHIRE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3628
Mailing Address - Country:US
Mailing Address - Phone:323-933-9244
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3628
Practice Address - Country:US
Practice Address - Phone:323-933-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA868531041C0700X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical