MEDICARE: MS. NATALIA RIVAS CADDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1023210820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NATALIA RIVAS CADDE

Provider Business Mailing Address
First Line	:	1220 MADISON AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-3691
Country	:	US
Telephone Number	:	619-429-4117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 PALM AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-1011
Country	:	US
Telephone Number	:	629-429-4117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	10/16/2008

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