Healthcare Provider Details

I. General information

NPI: 1104944586
Provider Name (Legal Business Name): VICTOR MESSINA ACEDO CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10159 MISSION GORGE RD
SANTEE CA
92071-3857
US

IV. Provider business mailing address

3635 RUFFIN RD STE 100
SAN DIEGO CA
92123-1853
US

V. Phone/Fax

Practice location:
  • Phone: 760-227-1380
  • Fax: 619-588-6282
Mailing address:
  • Phone: 858-300-0460
  • Fax: 858-300-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01-042565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: