MEDICARE: JOHANNA INES UGAZ GAVIDIA

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1700686094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA INES UGAZ GAVIDIA

Provider Business Mailing Address
First Line	:	4849 EL CEMONTE AVE APT 173
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-4480
Country	:	US
Telephone Number	:	857-262-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 EL CEMONTE AVE APT 173
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-4480
Country	:	US
Telephone Number	:	857-262-7222
Fax Number	:

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

Provider Enumeration Date	:	03/15/2025
Last Update Date	:	03/15/2025

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