Basic Information
Provider Information
NPI: 1003000266
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUDIG
FirstName: BEVERLY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3331 POWER INN RD
Address2: SUITE 450
City: SACRAMENTO
State: CA
PostalCode: 958263889
CountryCode: US
TelephoneNumber: 9168767624
FaxNumber:  
Practice Location
Address1: 3331 POWER INN RD
Address2: SUITE 450
City: SACRAMENTO
State: CA
PostalCode: 958263889
CountryCode: US
TelephoneNumber: 9168767624
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/30/2007
LastUpdateDate: 08/30/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251B00000X  Y AgenciesCase Management 

No ID Information.


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