MEDICARE: PLOUA VUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 21584	CA

General Provider Information

NPI Number	:	1053782219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PLOUA VUE

Provider Business Mailing Address
First Line	:	4406 PALM AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95842-3359
Country	:	US
Telephone Number	:	916-483-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	4406 PALM AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95842-3359
Country	:	US
Telephone Number	:	916-897-6971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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Directions to “ PLOUA VUE ” Practice Location

Language	Start Address	Practice Location

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