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NPI Code Detail

MEDICARE: TARA JEANINE BUDINGER PH D

MEDICARE: TARA JEANINE BUDINGER PH D
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
1103T00000XPsychologist14245CA
2103TC0700XClinical Psychologist2887CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00228619OTHERRR MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831163716
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA JEANINE BUDINGER PH D
Provider Business Mailing Address
First Line : 751 LOMBARDI CT
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-6798
Country : US
Telephone Number : 707-547-2220
Fax Number : 707-547-2229
Provider Business Practice Location Address
First Line : 751 LOMBARDI CT
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-6798
Country : US
Telephone Number : 707-547-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 02/04/2016

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Directions to “ TARA JEANINE BUDINGER PH D” Practice Location

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