Basic Information
| Provider Information | |||||||||
| NPI: | 1588117089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUS | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E MOUNTAIN VIEW ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923112814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602567279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 E MOUNTAIN VIEW ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923112814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602567279 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2016 | ||||||||
| LastUpdateDate: | 08/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | D6779422 | CA | Y |
No ID Information.