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NPI Code Detail

MEDICARE: MR. BRIAN ARTHUR HAESLOOP

MEDICARE: MR. BRIAN ARTHUR HAESLOOP
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
2101YA0400XAddiction (Substance Use Disorder) CounselorA06960315CA

General Provider Information

NPI Number : 1336472117
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN ARTHUR HAESLOOP
Provider Business Mailing Address
First Line : 2501 LOS FELIZ WAY
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-5344
Country : US
Telephone Number : 916-402-9185
Fax Number :
Provider Business Practice Location Address
First Line : 3990 INDUSTRIAL BLVD
Second Line :
City : WEST SACRAMENTO
State : CA
Zip : 95691-3430
Country : US
Telephone Number : 916-796-0020
Fax Number : 916-796-0045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2009
Last Update Date : 09/17/2021

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