Healthcare Provider Details

I. General information

NPI: 1427309525
Provider Name (Legal Business Name): HILARIO FORTUNA CADC-II, ICADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 LOCKSLEY LN STE 101
AUBURN CA
95602-2050
US

IV. Provider business mailing address

12183 LOCKSLEY LN STE 101
AUBURN CA
95602-2050
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberF1009191239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA017950315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: