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NPI Code Detail

MEDICARE: MANUEL JOHN BEDARD CATC

MEDICARE: MANUEL JOHN BEDARD CATC
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) Counselor

General Provider Information

NPI Number : 1912421223
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANUEL JOHN BEDARD CATC
Provider Business Mailing Address
First Line : 1400 N JOHNSON AVE STE 101
Second Line :
City : EL CAJON
State : CA
Zip : 92020-1651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 619-393-2072
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2017
Last Update Date : 09/07/2023

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