Healthcare Provider Details

I. General information

NPI: 1942967062
Provider Name (Legal Business Name): STEPHANIE YAKUPITIYAGE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2086 UNION ST
SAN FRANCISCO CA
94123-4103
US

IV. Provider business mailing address

565 ALBION AVE
WOODSIDE CA
94062-3605
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-9008
  • Fax:
Mailing address:
  • Phone: 650-863-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: