| Organization Name: | BOUCH MEDICAL CORPORATION |
| NPI Number: | 1720467962 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUMMER BEGIN (PRACTICE MANAGER) |
| Mailing Address: | 435 Petaluma Ave Ste 150 Sebastopol |
| State: | CA US |
| Postal Code: | 954724273 |
| Phone Number: | 7078617300 |
| Fax Number: | 7078238568 |
| NPI Enumeration Date: | 05/20/2015 |
| NPI Last Update Date: | 05/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | 20A9470 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |