Organization
BUPHANT SOCIETY
Active
Organization
BUPHANT SOCIETY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID GRAYSON (CEO)
(209) 670-6799
Entity
Organization
Contact information
Practice address
1045 N. ELDORADO, 11, STOCKTON, CA 95202
(209) 670-6799
Mailing address
1045 N. ELDORADO #11, STOCKTON, CA 95202
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
IMF 85548
CA
Other
Enumeration date
08/31/2015
Last updated
08/31/2015
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