Healthcare Provider Details

I. General information

NPI: 1255878187
Provider Name (Legal Business Name): DEBRA BUDDIE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19566 BURNSIDE CT
GRASS VALLEY CA
95945-9692
US

IV. Provider business mailing address

19566 BURNSIDE CT
GRASS VALLEY CA
95945-9692
US

V. Phone/Fax

Practice location:
  • Phone: 530-913-6347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: