Healthcare Provider Details

I. General information

NPI: 1104414028
Provider Name (Legal Business Name): UYAYI ACUPUNCTURE & HERBAL MEDICINE: A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W BENJAMIN HOLT DR STE B3
STOCKTON CA
95207-3958
US

IV. Provider business mailing address

10815 BEACHCOMBER DR
STOCKTON CA
95209-4275
US

V. Phone/Fax

Practice location:
  • Phone: 209-670-3847
  • Fax:
Mailing address:
  • Phone: 415-794-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS MARLON BUGARIN
Title or Position: CEO
Credential: L.AC.
Phone: 415-794-3206