MEDICARE: ANDREW DANIEL SCOGGINS CAADE#25391

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	25391	CA

General Provider Information

NPI Number	:	1306708029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW DANIEL SCOGGINS CAADE#25391

Provider Business Mailing Address
First Line	:	3424 COGSWELL RD APT 10
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2730
Country	:	US
Telephone Number	:	323-345-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 COGSWELL RD APT 10
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2730
Country	:	US
Telephone Number	:	323-345-7013
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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