Provider Demographics
NPI:1275341778
Name:BEGOVICH, DAVID MICHAEL (RADT-I)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:BEGOVICH
Suffix:
Gender:M
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 MERIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4765
Mailing Address - Country:US
Mailing Address - Phone:415-304-4187
Mailing Address - Fax:
Practice Address - Street 1:130 PROSPECTOR CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5119
Practice Address - Country:US
Practice Address - Phone:916-293-9667
Practice Address - Fax:916-673-9872
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1530511023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)