Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1336289818 |
---|---|
Provider Name | Mr. Herbert Ray Bumgart JR. |
First Address | El Centro, CA 92251 |
Second Address | El Centro, CA 92251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |