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NPI Code Detail

MEDICARE: MS. MARIE DOETTREL

MEDICARE: MS. MARIE DOETTREL
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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1240530117CA

General Provider Information

NPI Number : 1285177816
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIE DOETTREL
Provider Business Mailing Address
First Line : 660 E LOS ANGELES AVE STE B2
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-1884
Country : US
Telephone Number : 805-522-1844
Fax Number :
Provider Business Practice Location Address
First Line : 660 E LOS ANGELES AVE
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-1873
Country : US
Telephone Number : 805-522-1844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2016
Last Update Date : 01/12/2021

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