Healthcare Provider Details

I. General information

NPI: 1659500908
Provider Name (Legal Business Name): MARITES GUTIERREZ BUGAYONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 MISSION ST
SAN FRANCISCO CA
94112-1050
US

IV. Provider business mailing address

3998 MISSION ST
SAN FRANCISCO CA
94112-1050
US

V. Phone/Fax

Practice location:
  • Phone: 415-239-8511
  • Fax:
Mailing address:
  • Phone: 415-239-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL06688
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: