Provider Demographics
NPI:1164593653
Name:BACA, HUGH W (RDCS)
Entity Type:Individual
Prefix:MR
First Name:HUGH
Middle Name:W
Last Name:BACA
Suffix:
Gender:M
Credentials:RDCS
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Mailing Address - Street 1:2394 TELEGRAPH HL
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4054
Mailing Address - Country:US
Mailing Address - Phone:916-939-2287
Mailing Address - Fax:916-939-2287
Practice Address - Street 1:2394 TELEGRAPH HL
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4054
Practice Address - Country:US
Practice Address - Phone:916-939-2287
Practice Address - Fax:916-939-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40089246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16001ZMedicare PIN