Healthcare Provider Details

I. General information

NPI: 1649676057
Provider Name (Legal Business Name): MISS DANIELLE BADER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 3RD AVE STE C
CHULA VISTA CA
91911-1352
US

IV. Provider business mailing address

PO BOX 882231
SAN DIEGO CA
92168-2231
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-4661
  • Fax:
Mailing address:
  • Phone: 619-987-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: