MEDICARE: MR. VICTOR M METTLER CAADAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1043577273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR M METTLER CAADAC

Provider Business Mailing Address
First Line	:	12171 BROOKHAVEN PARK
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-2849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12171 BROOKHAVEN PARK
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-2849
Country	:	US
Telephone Number	:	562-428-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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