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NPI Code Detail

MEDICARE: CHARLES RICHARD CUMMINGS

MEDICARE:   CHARLES RICHARD CUMMINGS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1434290621CA

General Provider Information

NPI Number : 1013673268
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES RICHARD CUMMINGS
Provider Business Mailing Address
First Line : 1530 DALE ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-1519
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1530 DALE ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-1519
Country : US
Telephone Number : 619-915-5710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2021
Last Update Date : 11/11/2021

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Directions to “ CHARLES RICHARD CUMMINGS ” Practice Location

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