MEDICARE: TRADITION ONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	370012AN	CA

General Provider Information

NPI Number	:	1013031541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRADITION ONE

Provider Business Mailing Address
First Line	:	4104 DELTA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-4113
Country	:	US
Telephone Number	:	619-264-0141
Fax Number	:	619-264-7274

Provider Business Practice Location Address
First Line	:	4104 DELTA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-4113
Country	:	US
Telephone Number	:	619-264-0141
Fax Number	:	619-264-7274

Authorized Official
Title or Position	:	BOARD OF DIRECTOR-PRESIDENT
Name	:	TAMARA DENISE PARKER
Credential	:
Telephone Number	:	619-490-7703

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	04/02/2026

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Directions to “TRADITION ONE ” Practice Location

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