Provider Demographics
NPI:1700686094
Name:UGAZ GAVIDIA, JOHANNA INES
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:INES
Last Name:UGAZ GAVIDIA
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 1:4849 EL CEMONTE AVE APT 173
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4480
Mailing Address - Country:US
Mailing Address - Phone:857-262-7222
Mailing Address - Fax:
Practice Address - Street 1:4849 EL CEMONTE AVE APT 173
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4480
Practice Address - Country:US
Practice Address - Phone:857-262-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter