Doctor Name: | MICHAEL BOGREN |
NPI Number: | 1013133644 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 191 Harvey West Blvd Santa Cruz, CA - 950602126 |
Business Phone Number: | 8314691700 |
Business Fax Number: | |
Mailing Address: | 195 A Harvey West Blvd., WATSONVILLE |
State: | CA |
Postal Code: | 950605320 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 07/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |