Provider Demographics
NPI:1013406248
Name:UP CARE MED LLC
Entity Type:Organization
Organization Name:UP CARE MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-817-4586
Mailing Address - Street 1:4605 OLD MILL CT
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-8015
Mailing Address - Country:US
Mailing Address - Phone:209-817-4586
Mailing Address - Fax:
Practice Address - Street 1:4605 OLD MILL CT
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-8015
Practice Address - Country:US
Practice Address - Phone:209-817-4586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid