Healthcare Provider Details

I. General information

NPI: 1073704110
Provider Name (Legal Business Name): ROBERT VINCENT YAUCKOES LICAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 FRANKLIN ST
FRAMINGHAM MA
01702-2953
US

IV. Provider business mailing address

665 FRANKLIN ST
FRAMINGHAM MA
01702-2953
US

V. Phone/Fax

Practice location:
  • Phone: 508-405-2881
  • Fax:
Mailing address:
  • Phone: 508-405-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC226525
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: