Basic Information
| Provider Information | |||||||||
| NPI: | 1942474143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERDUGO | ||||||||
| FirstName: | BOBBY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1339 20TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298032 | ||||||||
| FaxNumber: | 3108298455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1339 20TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298032 | ||||||||
| FaxNumber: | 3108298455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.