Healthcare Provider Details

I. General information

NPI: 1306219050
Provider Name (Legal Business Name): MICHAEL A. CLOUD SR. SUDCC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 EUCLID AVE
SAN DIEGO CA
92105-5414
US

IV. Provider business mailing address

1733 EUCLID AVE
SAN DIEGO CA
92105-5414
US

V. Phone/Fax

Practice location:
  • Phone: 619-263-0433
  • Fax: 619-263-3992
Mailing address:
  • Phone: 619-263-0433
  • Fax: 619-263-3992

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 TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: