Healthcare Provider Details

I. General information

NPI: 1225806359
Provider Name (Legal Business Name): I AM RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 15TH ST STE 103
SAN DIEGO CA
92101-8098
US

IV. Provider business mailing address

845 15TH ST STE 103
SAN DIEGO CA
92101-8098
US

V. Phone/Fax

Practice location:
  • Phone: 425-344-3949
  • Fax:
Mailing address:
  • Phone: 425-344-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SOLOMON AGEZE
Title or Position: OWNER
Credential:
Phone: 425-344-3949