Provider Demographics
NPI:1972338382
Name:ALIBUDBUD, PHILIP AL (RN)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:AL
Last Name:ALIBUDBUD
Suffix:
Gender:U
Credentials:RN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5401 MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6850
Mailing Address - Country:US
Mailing Address - Phone:209-763-8058
Mailing Address - Fax:
Practice Address - Street 1:5401 MOONLIGHT WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6850
Practice Address - Country:US
Practice Address - Phone:209-763-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95032777363LG0600X
CA95022405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse