MEDICARE: GABRIEL RICHARD MALDONADO RADT I

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	RT1424451225	CA

General Provider Information

NPI Number	:	1962366823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL RICHARD MALDONADO RADT I

Provider Business Mailing Address
First Line	:	722 WASHINGTON ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-3925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	722 WASHINGTON ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-3925
Country	:	US
Telephone Number	:	510-815-8008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/17/2025

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