Provider Demographics
NPI:1134690902
Name:BUNDY, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 RIO LINDO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1973
Mailing Address - Country:US
Mailing Address - Phone:530-893-4784
Mailing Address - Fax:530-893-6144
Practice Address - Street 1:287 RIO LINDO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1973
Practice Address - Country:US
Practice Address - Phone:530-893-4784
Practice Address - Fax:530-893-6144
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003868803171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003868803OtherCASE MANAGEMENT