Basic Information
| Provider Information | |||||||||
| NPI: | 1215245907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUERLE | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | CONOR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2460 S BASCOM AVE APT 5 | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950084336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085157040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1885 LUNDY AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085037960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 02/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.