MEDICARE: MS. TRICIA DEBONE'

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	106H00000X	Marriage & Family Therapist	IMF 50472	CA

General Provider Information

NPI Number	:	1649381559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRICIA DEBONE'

Provider Business Mailing Address
First Line	:	5404 LAUREL HILLS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-3106
Country	:	US
Telephone Number	:	916-609-4007
Fax Number	:

Provider Business Practice Location Address
First Line	:	5404 LAUREL HILLS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-3106
Country	:	US
Telephone Number	:	916-609-4007
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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