Healthcare Provider Details

I. General information

NPI: 1982210142
Provider Name (Legal Business Name): THUPTEN GELEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BLACKHAWK PLAZA CIR STE 230
DANVILLE CA
94506-4648
US

IV. Provider business mailing address

4125 BLACKHAWK PLAZA CIR STE 230
DANVILLE CA
94506-4648
US

V. Phone/Fax

Practice location:
  • Phone: 844-262-8466
  • Fax:
Mailing address:
  • Phone: 844-262-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: