Healthcare Provider Details

I. General information

NPI: 1174029250
Provider Name (Legal Business Name): DAVID EDWARD SKONEZNY CADC-II, ICADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27281 LAS RAMBLAS
MISSION VIEJO CA
92691-6324
US

IV. Provider business mailing address

9918 BLACK HILLS LN
SANTEE CA
92071-1181
US

V. Phone/Fax

Practice location:
  • Phone: 714-865-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA014850315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: