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General NPI Number Information
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NPI Number | 1487356713
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Entity Type | Individual
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Provider Name | KASARA EILEEN MYRVOLD RADT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 23931 WARREN RD
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City | SAN JACINTO
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State | CA
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Zip | 92582-3795
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Country | US
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Telephone | 951-663-5690
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Fax |
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Provider Business Mailing Address
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Address Line | 31477 SUNSET AVE
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City | NUEVO
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State | CA
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Zip | 92567-8956
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Country | US
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Telephone | 951-663-5690
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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