Jeffrey Andersen
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · San Pedro, CA
NPI 1164071650 · NPPES record last updated Sep 6, 2019
Key facts
- NPI
- 1164071650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 92845 (CA)
- Practice address
- 270 W 14TH St # 27
San Pedro, CA 90731-4396 - Phone
- (310) 519-8723
- NPI assigned
- Sep 6, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 92845 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 92845 | CA | Yes |
Addresses
Primary practice location
270 W 14TH St # 27
San Pedro, CA 90731-4396
Mailing address
270 W 14TH St # 270
San Pedro, CA 90731-4396
Phone (310) 519-8723
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.