MEDICARE: MR. CASTLE MICHAEL BRUSA CADC-I

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	CI41480124	CA

General Provider Information

NPI Number	:	1649165978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CASTLE MICHAEL BRUSA CADC-I

Provider Business Mailing Address
First Line	:	5702 VANALDEN AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-1225
Country	:	US
Telephone Number	:	213-800-4067
Fax Number	:

Provider Business Practice Location Address
First Line	:	11150 W OLYMPIC BLVD STE 760
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1855
Country	:	US
Telephone Number	:	213-800-4067
Fax Number	:	310-894-5354

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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