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NPI Code Detail

MEDICARE: TINA ANN MATHEWS SUDCC IV

MEDICARE:   TINA ANN  MATHEWS  SUDCC IV
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) Counselor7347CA

General Provider Information

NPI Number : 1902070972
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA ANN MATHEWS SUDCC IV
Provider Business Mailing Address
First Line : 120 BIRMINGHAM DR STE 240A
Second Line :
City : CARDIFF
State : CA
Zip : 92007-1757
Country : US
Telephone Number : 858-208-0121
Fax Number : 858-381-9768
Provider Business Practice Location Address
First Line : 120 BIRMINGHAM DR STE 240A
Second Line :
City : CARDIFF
State : CA
Zip : 92007-1757
Country : US
Telephone Number : 858-208-0121
Fax Number : 858-381-9768
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2008
Last Update Date : 08/26/2022

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Directions to “ TINA ANN MATHEWS SUDCC IV” Practice Location

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