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NPI Code Detail

MEDICARE: MR. JOHN LUNDHOLM

MEDICARE: MR. JOHN LUNDHOLM
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1710064852
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN LUNDHOLM
Provider Business Mailing Address
First Line : 3735 BROADWAY
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-2926
Country : US
Telephone Number : 916-214-5665
Fax Number :
Provider Business Practice Location Address
First Line : 7650 AMHERST ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95832-1024
Country : US
Telephone Number : 916-665-1804
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ MR. JOHN LUNDHOLM ” Practice Location

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