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NPI Code Detail

MEDICARE: ERIC BURDETT RADT

MEDICARE: ERIC BURDETT RADT
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) Counselor

General Provider Information

NPI Number : 1306470109
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC BURDETT RADT
Provider Business Mailing Address
First Line : 2211 E OCEAN BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-2440
Country : US
Telephone Number : 562-434-4060
Fax Number : 562-457-3621
Provider Business Practice Location Address
First Line : 2135 E OCEAN BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-2434
Country : US
Telephone Number : 562-434-4060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2020
Last Update Date : 03/02/2020

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Directions to “ ERIC BURDETT RADT” Practice Location

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