=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003770660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE EMPOWER COLLECTIVE LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9805 CAMPO RD STE 165 P.O BOX 65
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91977-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-889-8728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9805 CAMPO RD STE 165
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91977-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-889-8728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ISABELLA F CAVELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-889-8728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------