Healthcare Provider Details

I. General information

NPI: 1518081926
Provider Name (Legal Business Name): MRS. MARY B BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

IV. Provider business mailing address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

V. Phone/Fax

Practice location:
  • Phone: 916-879-3920
  • Fax: 916-609-5160
Mailing address:
  • Phone: 916-879-3920
  • Fax: 916-609-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: