Provider Information for 1689994212
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BRUCE WALLACE BATES MFT
Sex: Male
NPI: 1689994212
Last Updated: 2010-06-05
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1689994212 | ||||||||
| Enumeration Date | 2010-06-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1304 E MAIN ST STE D VENTURA, CA 93001-3202 United States Phone: 310-579-5002 | Fax: | ||||||||
| Primary Practice Address | 1304 E MAIN ST STE D VENTURA, CA 93001-3202 United States Phone: 310-579-5002 | Fax: | ||||||||
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