Healthcare Provider Details

I. General information

NPI: 1437440211
Provider Name (Legal Business Name): JOSEPH NICK MACEDO CAADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALLERTON ST
REDWOOD CITY CA
94063-1519
US

IV. Provider business mailing address

500 ALLERTON ST
REDWOOD CITY CA
94063-1519
US

V. Phone/Fax

Practice location:
  • Phone: 650-599-9955
  • Fax: 650-599-9273
Mailing address:
  • Phone: 650-599-9955
  • Fax: 650-599-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC3360109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: