Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 29341 | CA |
NPI | 1093239089 |
---|---|
Provider Name | Dr. Megan E Tudor |
First Address | Sacramento, CA 95817-2310 |
Second Address | Sacramento, CA 95817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 04/04/2018 |