MEDICARE: MICHELLE RODARTE RADT

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	R1491471222	CA

General Provider Information

NPI Number	:	1811695588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RODARTE RADT

Provider Business Mailing Address
First Line	:	83912 AVENUE 45 STE 9
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-3338
Country	:	US
Telephone Number	:	951-955-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	83912 AVENUE 45
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-7351
Country	:	US
Telephone Number	:	442-933-1753
Fax Number	:

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

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	04/17/2023

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Directions to “ MICHELLE RODARTE RADT” Practice Location

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