Healthcare Provider Details

I. General information

NPI: 1760506513
Provider Name (Legal Business Name): BUHARI & DEGUZMAN, INC. A MED CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA STREET SUITE 401
STOCKTON CA
95204-6033
US

IV. Provider business mailing address

1805 N CALIFORNIA STREET SUITE 401
STOCKTON CA
95204-6033
US

V. Phone/Fax

Practice location:
  • Phone: 209-477-4421
  • Fax: 209-477-7211
Mailing address:
  • Phone: 209-477-4421
  • Fax: 209-477-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA82278
License Number StateCA

VIII. Authorized Official

Name: DR. SHIRAZ BUHARI
Title or Position: MD
Credential: MD
Phone: 209-477-4421