Healthcare Provider Details

I. General information

NPI: 1285842567
Provider Name (Legal Business Name): AMBER JEAN NIEVES CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE A
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

1105 N IVY ST
ESCONDIDO CA
92026-3030
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax:
Mailing address:
  • Phone: 760-532-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01-094488
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC7581214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: