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General NPI Number Information
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NPI Number | 1447017488
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Entity Type | Individual
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Provider Name | MARK JUDE RYWELSKI
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Gender | Male
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 1530 DALE ST
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City | SAN DIEGO
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State | CA
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Zip | 92102-1519
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Country | US
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Telephone | 619-915-5710
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 CEDAR ST
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City | SAN DIEGO
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State | CA
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Zip | 92102-1599
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Country | US
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Telephone | 619-239-7370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1538671223
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License Number State | CA
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