Healthcare Provider Details

I. General information

NPI: 1902725567
Provider Name (Legal Business Name): DEBORAH UYTIEPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOQUEL AVE STE D
SANTA CRUZ CA
95062-2322
US

IV. Provider business mailing address

400 BAR KING RD
BOULDER CREEK CA
95006-9730
US

V. Phone/Fax

Practice location:
  • Phone: 831-281-4217
  • Fax:
Mailing address:
  • Phone: 415-902-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number38295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: