Provider Demographics
NPI:1851191290
Name:BOUIE, DARYL (CHW, PSS)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:BOUIE
Suffix:
Gender:M
Credentials:CHW, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 CASANOVA AVE APT 34
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6821
Mailing Address - Country:US
Mailing Address - Phone:831-275-8456
Mailing Address - Fax:
Practice Address - Street 1:930 CASANOVA AVE APT 34
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6821
Practice Address - Country:US
Practice Address - Phone:708-925-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
CAMPSS-SEVYIT175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist