Healthcare Provider Details

I. General information

NPI: 1700271152
Provider Name (Legal Business Name): TRACY UPTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 W GOSHEN AVE STE 326
VISALIA CA
93291-8619
US

IV. Provider business mailing address

5211 W GOSHEN AVE STE 326
VISALIA CA
93291-8619
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA156819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: