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NPI Code Detail

MEDICARE: STACY PAULA OURIQUE

MEDICARE: STACY PAULA OURIQUE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA
2106H00000XMarriage & Family Therapist145315CA

General Provider Information

NPI Number : 1891303475
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY PAULA OURIQUE
Provider Business Mailing Address
First Line : 751 ALAMEDA DE LAS PULGAS
Second Line :
City : BELMONT
State : CA
Zip : 94002-1606
Country : US
Telephone Number : 510-224-5504
Fax Number :
Provider Business Practice Location Address
First Line : 751 ALAMEDA DE LAS PULGAS
Second Line :
City : BELMONT
State : CA
Zip : 94002-1606
Country : US
Telephone Number : 510-224-5504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2020
Last Update Date : 02/04/2025

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Directions to “ STACY PAULA OURIQUE ” Practice Location

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