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General NPI Number Information
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NPI Number | 1679430219
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Entity Type | Individual
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Provider Name | MICHAEL DONALD PIVARAL ACSW
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Gender | Male
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 3551 CAMINO MIRA COSTA STE T
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3508
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Country | US
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Telephone | 949-272-4444
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Fax | 949-272-4445
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Provider Business Mailing Address
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Address Line | 3551 CAMINO MIRA COSTA STE T
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3508
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Country | US
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Telephone | 949-272-4444
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Fax | 949-272-4445
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 133217
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License Number State | CA
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