Healthcare Provider Details

I. General information

NPI: 1215143961
Provider Name (Legal Business Name): NORMITA MATIAS AYUPAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JOSE FIGUERES AVE
SAN JOSE CA
95116-2022
US

IV. Provider business mailing address

2709 BEACHWOOD CT
HAYWARD CA
94545-1236
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-3120
  • Fax: 408-347-3121
Mailing address:
  • Phone: 408-347-3120
  • Fax: 408-347-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA36795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: