Provider Demographics
NPI:1760506513
Name:BUHARI & DEGUZMAN, INC. A MED CORP
Entity Type:Organization
Organization Name:BUHARI & DEGUZMAN, INC. A MED CORP
Other - Org Name:ANCHOR FAMILY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-477-4421
Mailing Address - Street 1:1805 N CALIFORNIA STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6033
Mailing Address - Country:US
Mailing Address - Phone:209-477-4421
Mailing Address - Fax:209-477-7211
Practice Address - Street 1:1805 N CALIFORNIA STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6033
Practice Address - Country:US
Practice Address - Phone:209-477-4421
Practice Address - Fax:209-477-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82278204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700855418OtherBUHARI INDIVIDUAL NPI
CA1730158460OtherDEGUZMAN INDIVIDUAL NPI
CAY02271Medicare UPIN
CA1730158460OtherDEGUZMAN INDIVIDUAL NPI
CAH98314Medicare UPIN
CA1700855418OtherBUHARI INDIVIDUAL NPI