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NPI Code Detail

MEDICARE: MIGUEL GEORGE TROY RADT-I

MEDICARE: MIGUEL GEORGE TROY RADT-I
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) CounselorR1528700923CA

General Provider Information

NPI Number : 1649045980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIGUEL GEORGE TROY RADT-I
Provider Business Mailing Address
First Line : 1301 RICHMOND ST
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2428
Country : US
Telephone Number : 510-725-7346
Fax Number :
Provider Business Practice Location Address
First Line : 1820 SCENIC AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1395
Country : US
Telephone Number : 510-548-7270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2023
Last Update Date : 12/08/2023

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