Healthcare Provider Details

I. General information

NPI: 1538021183
Provider Name (Legal Business Name): ROBERT JOHN DRIGGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 NE MAPLE AVE
REDMOND OR
97756-8527
US

IV. Provider business mailing address

19628 CASMALIA ST
RIALTO CA
92377-4634
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-9577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: