Healthcare Provider Details

I. General information

NPI: 1831033604
Provider Name (Legal Business Name): MYRLA M LABUEN RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 CIELO AZUL WAY
DESERT HOT SPRINGS CA
92240-6235
US

IV. Provider business mailing address

15220 AVENIDA RAMBLA
DESERT HOT SPRINGS CA
92240-7019
US

V. Phone/Fax

Practice location:
  • Phone: 760-329-4673
  • Fax:
Mailing address:
  • Phone: 760-329-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1419790925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: