Healthcare Provider Details

I. General information

NPI: 1235465501
Provider Name (Legal Business Name): BEATRICE K DUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 T ST
SACRAMENTO CA
95811-6822
US

IV. Provider business mailing address

9589 FOUR WINDS DR #712
ELK GROVE CA
95758-7134
US

V. Phone/Fax

Practice location:
  • Phone: 916-558-4800
  • Fax: 916-558-4806
Mailing address:
  • Phone: 916-897-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP 14195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: