MEDICARE: STANISLAUS C UGBENE

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922196427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANISLAUS C UGBENE

Provider Business Mailing Address
First Line	:	2101 COURAGE DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6717
Country	:	US
Telephone Number	:	707-639-4675
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 NAPA VALLEY CORPORATE DR BLDG B
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-6216
Country	:	US
Telephone Number	:	707-227-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/12/2021

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