MEDICARE: I AM RECOVERY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	207QA0401X	Addiction Medicine (Family Medicine) Physician
3	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1225806359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I AM RECOVERY INC

Provider Business Mailing Address
First Line	:	845 15TH ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8098
Country	:	US
Telephone Number	:	425-344-3949
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 15TH ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8098
Country	:	US
Telephone Number	:	425-344-3949
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL SOLOMON AGEZE
Credential	:
Telephone Number	:	425-344-3949

Provider Enumeration Date	:	12/18/2023
Last Update Date	:	10/29/2024

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Directions to “I AM RECOVERY INC ” Practice Location

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