Healthcare Provider Details

I. General information

NPI: 1386748671
Provider Name (Legal Business Name): WILLIAM ANDREW HYMAN CACDII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 ENGINEER LANE
SEASIDE CA
93955
US

IV. Provider business mailing address

P.O. BOX 1083
MARNIA CA
93933
US

V. Phone/Fax

Practice location:
  • Phone: 831-883-3804
  • Fax:
Mailing address:
  • Phone: 831-578-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRA847404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: