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General NPI Number Information
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NPI Number | 1659408771
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Entity Type | Organization
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Legal Business Name | JACQUELINE M CALKIN MD AND ALISON A BOUDREAUX MD A PROFESSIONAL MEDICA
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 2625 FAIR OAKS BLVD SUITE 1
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City | SACRAMENTO
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State | CA
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Zip | 95864-4936
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Country | US
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Telephone | 916-646-3376
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Fax | 916-646-3336
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Provider Business Mailing Address
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Address Line | 2625 FAIR OAKS BLVD SUITE 1
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City | SACRAMENTO
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State | CA
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Zip | 95864-4936
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Country | US
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Telephone | 916-646-3376
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Fax | 916-646-3336
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ALISON ANN BOUDREAUX
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Credential | MD
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Telephone | 916-646-3376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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