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NPI Code Detail

MEDICARE: MS. MELISSA JANE LADNER RAS

MEDICARE: MS. MELISSA JANE LADNER RAS
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) CounselorL0412061209CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1373727OTHERCAPROVIDER NUMBER

General Provider Information

NPI Number : 1922215060
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA JANE LADNER RAS
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 : 619-820-0006
Fax Number : 619-442-1101
Provider Business Practice Location Address
First Line : 1400 N JOHNSON AVE STE 101
Second Line :
City : EL CAJON
State : CA
Zip : 92020-1651
Country : US
Telephone Number : 619-820-0006
Fax Number : 619-442-1101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 07/30/2007

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