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General NPI Number Information
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NPI Number | 1730431966
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Entity Type | Individual
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Provider Name | ERNIE JOHN TAIMANGLO LAADC
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Gender | Male
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 338 W LEXINGTON AVE
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City | EL CAJON
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State | CA
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Zip | 92020-4465
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Country | US
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Telephone | 619-255-5499
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Fax |
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Provider Business Mailing Address
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Address Line | 741 CARLOW CT
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City | EL CAJON
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State | CA
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Zip | 92020-2011
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Country | US
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Telephone | 619-750-5871
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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 | LR05710121
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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 | 091760-III
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License Number State | CA
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