Provider Demographics
NPI:1336260942
Name:BOMSE, RUBEN MEYER
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:MEYER
Last Name:BOMSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2557
Mailing Address - Country:US
Mailing Address - Phone:415-505-1355
Mailing Address - Fax:
Practice Address - Street 1:1834 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1516
Practice Address - Country:US
Practice Address - Phone:510-845-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA18251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health