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NPI Code Detail

MEDICARE: JUDY DANIELLE BACUS

MEDICARE: JUDY DANIELLE BACUS
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
1171M00000XCase Manager/Care CoordinatorCA

General Provider Information

NPI Number : 1275964041
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY DANIELLE BACUS
Provider Business Mailing Address
First Line : 1624 SANTA CLARA DR STE 145
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3500
Country : US
Telephone Number : 916-779-2455
Fax Number : 916-588-2880
Provider Business Practice Location Address
First Line : 1624 SANTA CLARA DR STE 145
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3500
Country : US
Telephone Number : 916-779-2455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2013
Last Update Date : 03/17/2018

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Directions to “ JUDY DANIELLE BACUS ” Practice Location

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