Provider Demographics
NPI:1285268730
Name:BAUMGARTEN, DEBORAH PAOLA
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PAOLA
Last Name:BAUMGARTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CANYON OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1734
Mailing Address - Country:US
Mailing Address - Phone:415-867-8575
Mailing Address - Fax:
Practice Address - Street 1:350 GATE 5 RD
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2805
Practice Address - Country:US
Practice Address - Phone:415-867-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1822225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty