Provider Demographics
NPI:1780973545
Name:UGARTE, NOEMI
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:UGARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 W CULVER AVE
Mailing Address - Street 2:# 33
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 W CULVER AVE
Practice Address - Street 2:# 33
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4118
Practice Address - Country:US
Practice Address - Phone:714-262-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist