Healthcare Provider Details

I. General information

NPI: 1124656137
Provider Name (Legal Business Name): YUXI GUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MAIN ST
WATSONVILLE CA
95076-3092
US

IV. Provider business mailing address

1820 MAIN ST
WATSONVILLE CA
95076-3092
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-4227
  • Fax: 831-728-0410
Mailing address:
  • Phone: 831-728-4227
  • Fax: 831-728-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: