Provider Demographics
NPI:1104946169
Name:BAUER, WAYNE
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:BAUER
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 1:722 HILL ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4465
Mailing Address - Country:US
Mailing Address - Phone:310-450-5142
Mailing Address - Fax:
Practice Address - Street 1:2701 OCEAN PARK BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5219
Practice Address - Country:US
Practice Address - Phone:310-392-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator