MEDICARE: MR. RUBEN PRECIADO

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	APCC19914	CA

General Provider Information

NPI Number	:	1760226112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUBEN PRECIADO

Provider Business Mailing Address
First Line	:	1449 N VISTA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4209
Country	:	US
Telephone Number	:	760-586-9165
Fax Number	:	760-586-9165

Provider Business Practice Location Address
First Line	:	2900 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4265
Country	:	US
Telephone Number	:
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	09/25/2025

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