Regan Baudendistel
Individual provider Active NPI Counselor · Ross, CA
NPI 1114558186 · NPPES record last updated Jan 29, 2020
Key facts
- NPI
- 1114558186
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 47 Sir Francis Drake Blvd
Ross, CA 94957-9601 - Phone
- (818) 926-8401
- NPI assigned
- Jan 29, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
47 Sir Francis Drake Blvd
Ross, CA 94957-9601
Mailing address
PO Box 1446
Ross, CA 94957-1446
Phone (818) 926-8401
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | lifecoachcenrtal.expert | Direct |
Other providers in Ross, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.