MEDICARE: YSA DRUCK ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	NONE	CA

General Provider Information

NPI Number	:	1063275238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YSA DRUCK ATC

Provider Business Mailing Address
First Line	:	14 STEPHENS CT
Second Line	:
City	:	CROCKETT
State	:	CA
Zip	:	94525-1420
Country	:	US
Telephone Number	:	510-367-7899
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 3RD ST
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-4126
Country	:	US
Telephone Number	:	510-367-7899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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Directions to “ YSA DRUCK ATC” Practice Location

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