Healthcare Provider Details

I. General information

NPI: 1013406248
Provider Name (Legal Business Name): UP CARE MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 OLD MILL CT
SALIDA CA
95368-8015
US

IV. Provider business mailing address

4605 OLD MILL CT
SALIDA CA
95368-8015
US

V. Phone/Fax

Practice location:
  • Phone: 209-817-4586
  • Fax:
Mailing address:
  • Phone: 209-817-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL REITZ
Title or Position: PRESIDENT
Credential:
Phone: 209-817-4586