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NPI Code Detail

MEDICARE: TINA MARIE AYDELOTTE

MEDICARE: TINA MARIE AYDELOTTE
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) Counselor25369CA

General Provider Information

NPI Number : 1831015247
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE AYDELOTTE
Provider Business Mailing Address
First Line : 9140 VAN NUYS BLVD
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-6727
Country : US
Telephone Number : 818-895-2206
Fax Number :
Provider Business Practice Location Address
First Line : 9140 VAN NUYS BLVD
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-6727
Country : US
Telephone Number : 818-895-2206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2026
Last Update Date : 06/29/2026

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Directions to “ TINA MARIE AYDELOTTE ” Practice Location

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