MEDICARE: MICHAELA MARIE ABREU SUDRC

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	24551	CA

General Provider Information

NPI Number	:	1457206542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA MARIE ABREU SUDRC

Provider Business Mailing Address
First Line	:	1432 PEARSON AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-2436
Country	:	US
Telephone Number	:	415-862-2810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 PEARSON AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-2436
Country	:	US
Telephone Number	:	415-862-2810
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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