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NPI Code Detail

MEDICARE: CEDRIC DUNN SR.

MEDICARE: CEDRIC DUNN SR.
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
1324500000XSubstance Abuse Rehabilitation Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1410020DNOTHERCACASA AZTLAN

General Provider Information

NPI Number : 1962763821
Entity Type Code : Individual
Provider Name (Legal Business Name) : CEDRIC DUNN SR.
Provider Business Mailing Address
First Line : 301 GRAND AVE STE 301
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-3641
Country : US
Telephone Number : 650-244-1444
Fax Number :
Provider Business Practice Location Address
First Line : 301 GRAND AVE STE 301
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-3641
Country : US
Telephone Number : 650-244-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 06/06/2012

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Directions to “ CEDRIC DUNN SR. ” Practice Location

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