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General NPI Number Information
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NPI Number | 1770859647
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Entity Type | Individual
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Provider Name | MICHAEL L. RED CATC
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Gender | Male
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 637 SO. VAN NESS AVE.
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City | SAN FRANCISCO
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State | CA
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Zip | 94110
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Country | US
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Telephone | 415-293-7320
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Fax | 415-626-9188
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Provider Business Mailing Address
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Address Line | 637 S VAN NESS AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-1305
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Country | US
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Telephone | 415-293-7320
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Fax | 415-626-9188
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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