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NPI Code Detail

MEDICARE: MEXICAN AMERICAN ADDICTION PROGRAM

MEDICARE: MEXICAN AMERICAN ADDICTION PROGRAM
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center340004ENCA

General Provider Information

NPI Number : 1861837049
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEXICAN AMERICAN ADDICTION PROGRAM
Provider Business Mailing Address
First Line : 4241 FLORIN RD
Second Line : SUITE 65
City : SACRAMENTO
State : CA
Zip : 95823-2535
Country : US
Telephone Number : 916-394-2323
Fax Number : 916-394-2480
Provider Business Practice Location Address
First Line : 3628 MADISON AVE
Second Line : SUITE 21
City : NORTH HIGHLANDS
State : CA
Zip : 95660-5069
Country : US
Telephone Number : 916-331-4500
Fax Number : 916-331-4501
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. PAUL CRUZ
Credential :
Telephone Number : 916-394-4381
Provider Enumeration Date : 05/01/2013
Last Update Date : 03/19/2014

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