MEDICARE: CYNTHIA UGARTE COA, OSA

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	156FX1101X	Ophthalmic Assistant	222629	NV

General Provider Information

NPI Number	:	1447887732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA UGARTE COA, OSA

Provider Business Mailing Address
First Line	:	1525 VISTA LN STE 110
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4633
Country	:	US
Telephone Number	:	775-283-4000
Fax Number	:	775-283-4001

Provider Business Practice Location Address
First Line	:	1525 VISTA LN STE 110
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4633
Country	:	US
Telephone Number	:	775-283-4000
Fax Number	:	775-283-4001

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	03/25/2020

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