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General NPI Number Information
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NPI Number | 1093239089
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Entity Type | Individual
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Provider Name | MEGAN E TUDOR PHD
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 2825 50TH ST UC DAVIS MIND INSTITUTE
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 909-556-9641
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 50TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-2310
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Country | US
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Telephone | 916-703-0365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 29341
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License Number State | CA
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