Healthcare Provider Details

I. General information

NPI: 1801282926
Provider Name (Legal Business Name): JOSE BUGAY D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 GREEN VALLEY RD
FREEDOM CA
95019-3135
US

IV. Provider business mailing address

212 GREEN VALLEY RD
FREEDOM CA
95019-3135
US

V. Phone/Fax

Practice location:
  • Phone: 831-536-5500
  • Fax: 833-264-6644
Mailing address:
  • Phone: 831-536-5500
  • Fax: 833-264-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 27295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: