Healthcare Provider Details

I. General information

NPI: 1053900100
Provider Name (Legal Business Name): RECOVER ADDICTION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CAMINO DEL MAR STE 465
DEL MAR CA
92014-2605
US

IV. Provider business mailing address

1155 CAMINO DEL MAR STE 465
DEL MAR CA
92014-2605
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-8546
  • Fax:
Mailing address:
  • Phone: 760-815-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS DAVID GULINO
Title or Position: CEO
Credential:
Phone: 858-208-0121