Individual
STACY ROUDEBUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 FIRETHORN DR, ROHNERT PARK, CA 94928-1321
(619) 723-0385
Mailing address
308 FIRETHORN DR, ROHNERT PARK, CA 94928-1321
(619) 723-0385
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
B6655711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B6655711
—
CA
Enumeration date
09/25/2015
Last updated
09/25/2015
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