Robert Eugene Gideon, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1455910122 Issued in CA

Practice address

1501 Imperial Ave
San Diego, CA 92101-7638

Phone

(619) 865-1454

NPI assigned

Jul 12, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1215616768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8910 CLAIREMONT MESA BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-514-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 IMPERIAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921017638",
            "telephone_number": "619-865-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIDEON",
        "first_name": "ROBERT",
        "middle_name": "EUGENE",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-12",
        "last_updated": "2025-07-21",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1455910122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fregenet Zekiewos Gichamo, MD
• Ethan Eduardo Giddens
• Sophia Giddens, BCBA
• William Twain Giddens I
• Leland M Giddings, M.D.
• Sianna Joyce Gideon
• David Gidley, M.S., CCC-A
• Renita Gidlund, BCBA
• Rita Gidwaney, M.D.
• Pradeep Gidwani, MD

• Addiction (Substance Use Disorder) Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.