Stacy Roudebush

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

B6655711 Issued in CA

Practice address

308 Firethorn Dr
Rohnert Park, CA 94928-1321

Phone

(619) 723-0385

NPI assigned

Sep 25, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443139200000",
    "number": "1730559303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 FIRETHORN DR",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949281321",
            "telephone_number": "619-723-0385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 FIRETHORN DR",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949281321",
            "telephone_number": "619-723-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUDEBUSH",
        "first_name": "STACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-25",
        "last_updated": "2015-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "B6655711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B6655711",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Geronimo Fidel Romero, DDS
• Ronald J Martin OD a Professional Optometric Corporation (Vision Health Optometry)
• Ronald Lee Harris (Sonoma Eye Care Optometric Associates)
• Meghan Rondon
• Jordan Prosser Rose, FNP
• Patricia L. Rozenoff, FNP
• Jocelyn Rucker
• Diane Lamphier Ruddell, LCSW
• Joshua Ruiz, A.T.C.
• Rodney Ruppert II

• Substance Abuse Rehabilitation Facility in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.