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NPI Code Detail

MEDICARE: EBONY HUDSON

MEDICARE: EBONY HUDSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1568978674
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY HUDSON
Provider Business Mailing Address
First Line : 2102 PROMISE WAY
Second Line :
City : SACRAMENTO
State : CA
Zip : 95835-2103
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2102 PROMISE WAY
Second Line :
City : SACRAMENTO
State : CA
Zip : 95835-2103
Country : US
Telephone Number : 916-662-5764
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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