MEDICARE: WARREN ALDRICH CADTP

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist		CA

General Provider Information

NPI Number	:	1396588596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN ALDRICH CADTP

Provider Business Mailing Address
First Line	:	4369 SARDONYX ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1846
Country	:	US
Telephone Number	:	512-632-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	4369 SARDONYX ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1846
Country	:	US
Telephone Number	:	512-632-2344
Fax Number	:

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

Provider Enumeration Date	:	06/15/2024
Last Update Date	:	06/15/2024

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