Provider Demographics
NPI:1255899464
Name:CHEBUKINA, MARGARITA PAVLOVNA
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:PAVLOVNA
Last Name:CHEBUKINA
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 1:4540 HARLIN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9716
Mailing Address - Country:US
Mailing Address - Phone:916-364-7800
Mailing Address - Fax:
Practice Address - Street 1:2241 LAVA RIDGE CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3034
Practice Address - Country:US
Practice Address - Phone:916-918-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician