MEDICARE: MS. THERESA MARIE HASEGAWA CADC II, ICADC

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	A8572106	CA

General Provider Information

NPI Number	:	1982721478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA MARIE HASEGAWA CADC II, ICADC

Provider Business Mailing Address
First Line	:	504 W VISTA WAY
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-5704
Country	:	US
Telephone Number	:	760-940-1836
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 W VISTA WAY
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-5704
Country	:	US
Telephone Number	:	760-940-1836
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/21/2022

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