MEDICARE: DR. DALE MICHAEL APODACA M.D.

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	G74391	CA

General Provider Information

NPI Number	:	1598036436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE MICHAEL APODACA M.D.

Provider Business Mailing Address
First Line	:	3909 HENRY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1623
Country	:	US
Telephone Number	:	619-291-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 HENRY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1623
Country	:	US
Telephone Number	:	619-291-5522
Fax Number	:

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

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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