Provider Demographics
NPI:1992915839
Name:BUMBY, NOREEN (DO)
Entity type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:
Last Name:BUMBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NOREEN
Other - Middle Name:ANNE
Other - Last Name:BUMBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:72171 HIGHWAY 111
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4219
Mailing Address - Country:US
Mailing Address - Phone:760-776-4665
Mailing Address - Fax:760-776-4652
Practice Address - Street 1:72171 HIGHWAY 111
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4219
Practice Address - Country:US
Practice Address - Phone:760-776-4665
Practice Address - Fax:760-776-4652
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020A64412084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A64410Medicare ID - Type UnspecifiedMDCARE