Healthcare Provider Details

I. General information

NPI: 1366171605
Provider Name (Legal Business Name): BLUE OAK CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 E PIMA ST
TUCSON AZ
85712-3317
US

IV. Provider business mailing address

4008 E PIMA ST
TUCSON AZ
85712-3317
US

V. Phone/Fax

Practice location:
  • Phone: 520-322-9355
  • Fax: 520-322-9359
Mailing address:
  • Phone: 520-322-9355
  • Fax: 520-322-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE STARK
Title or Position: OWNER
Credential: NMD
Phone: 520-322-9355