Healthcare Provider Details

I. General information

NPI: 1982062501
Provider Name (Legal Business Name): READY4CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 DRY CREEK RD
RIO LINDA CA
95673-4412
US

IV. Provider business mailing address

6309 DRY CREEK RD
RIO LINDA CA
95673-4412
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-2725
  • Fax:
Mailing address:
  • Phone: 916-566-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LEO ANTHONY VASQUEZ
Title or Position: PRESIDENT
Credential: BSW
Phone: 916-821-9090