Healthcare Provider Details

I. General information

NPI: 1073881868
Provider Name (Legal Business Name): MR. DARREN SCOTT YEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16088 PENN AVE
SAN LORENZO CA
94580-1009
US

IV. Provider business mailing address

16088 PENN AVE
SAN LORENZO CA
94580-1009
US

V. Phone/Fax

Practice location:
  • Phone: 925-788-7429
  • Fax:
Mailing address:
  • Phone: 925-788-7429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: