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NPI Code Detail

MEDICARE: RICHARD D WEST M.A.

MEDICARE: RICHARD D WEST M.A.
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) CounselorPSB 34160CA
2103TC0700XClinical PsychologistPSB 34160CA
3103TP2701XGroup Psychotherapy PsychologistPSB 34160CA

General Provider Information

NPI Number : 1588806681
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD D WEST M.A.
Provider Business Mailing Address
First Line : 3411 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4906
Country : US
Telephone Number : 619-274-4500
Fax Number :
Provider Business Practice Location Address
First Line : 3411 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4906
Country : US
Telephone Number : 619-274-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2009
Last Update Date : 07/06/2011

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