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NPI Code Detail

MEDICARE: DONNA MARIE EARLES

MEDICARE: DONNA MARIE EARLES
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) Counselor

General Provider Information

NPI Number : 1912140260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA MARIE EARLES
Provider Business Mailing Address
First Line : 3501 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4515
Country : US
Telephone Number : 562-981-1501
Fax Number : 562-981-1502
Provider Business Practice Location Address
First Line : 3501 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4515
Country : US
Telephone Number : 562-981-1501
Fax Number : 562-981-1502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2009
Last Update Date : 04/16/2009

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Directions to “ DONNA MARIE EARLES ” Practice Location

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