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General NPI Number Information
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NPI Number | 1841273497
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Entity Type | Individual
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Provider Name | COLLEEN SKY BAUCOM-PRO RD
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Gender | Female
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 2221 STOCKTON BLVD 3RD FLOOR
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City | SACRAMENTO
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State | CA
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Zip | 95817-1418
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Country | US
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Telephone | 916-734-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 2039 ALTA LOMA ST
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City | DAVIS
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State | CA
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Zip | 95616-0713
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Country | US
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Telephone | 916-233-6110
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 944951
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License Number State | CA
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