Healthcare Provider Details

I. General information

NPI: 1659408771
Provider Name (Legal Business Name): JACQUELINE M CALKIN MD AND ALISON A BOUDREAUX MD A PROFESSIONAL MEDICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/18/2016
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 Number
License Number State

VIII. Authorized Official

Name: DR. ALISON ANN BOUDREAUX
Title or Position: PHYSICIAN
Credential: MD
Phone: 916-646-3376