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NPI Code Detail

MEDICARE: GARRETT JOSEPH PRADARELLI CATC-II

MEDICARE: GARRETT JOSEPH PRADARELLI CATC-II
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) Counselor2314647-IIICA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1528614708
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARRETT JOSEPH PRADARELLI CATC-II
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2300
Fax Number :
Provider Business Practice Location Address
First Line : 5472 EL CAJON BLVD STE 101
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-3651
Country : US
Telephone Number : 619-269-0836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2019
Last Update Date : 06/08/2026

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Directions to “ GARRETT JOSEPH PRADARELLI CATC-II” Practice Location

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