Healthcare Provider Details

I. General information

NPI: 1093782120
Provider Name (Legal Business Name): ALISON ANN BOUDREAUX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 FAIR OAKS BLVD SUITE 1
SACRAMENTO CA
95864-4936
US

IV. Provider business mailing address

2625 FAIR OAKS BLVD SUITE 1
SACRAMENTO CA
95864-4936
US

V. Phone/Fax

Practice location:
  • Phone: 916-646-3376
  • Fax: 916-646-3336
Mailing address:
  • Phone: 916-646-3376
  • Fax: 916-646-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG076779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: