Healthcare Provider Details

I. General information

NPI: 1457981623
Provider Name (Legal Business Name): HANS KARL KOWOLL CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83912 AVENUE 45 STE 9
INDIO CA
92201-3338
US

IV. Provider business mailing address

83912 AVENUE 45 STE 9
INDIO CA
92201-3338
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-0754
  • Fax:
Mailing address:
  • Phone: 760-347-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAO6195122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: