Healthcare Provider Details

I. General information

NPI: 1457185167
Provider Name (Legal Business Name): SAINJARGAL UUGANBAYAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 CIVIC CT
CONCORD CA
94520-7914
US

IV. Provider business mailing address

1465 CIVIC CT
CONCORD CA
94520-7914
US

V. Phone/Fax

Practice location:
  • Phone: 510-735-4414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: