Samuel Dudley
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Bloomington, CA
NPI 1669074142 · NPPES record last updated Nov 10, 2020
Key facts
- NPI
- 1669074142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Practice address
- 18612 Santa Ana Ave
Bloomington, CA 92316-2639 - Phone
- (909) 421-7120
- NPI assigned
- Nov 10, 2020
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Yes |
Addresses
Primary practice location
18612 Santa Ana Ave
Bloomington, CA 92316-2639
Mailing address
18612 Santa Ana Ave
Bloomington, CA 92316-2639
Phone (909) 421-7120
Other providers in Bloomington, CA
- Tamsen Debois
- Steven Devote
- Valerie Diaz
- Keiana Dobson
- Jennifer Doss
- Ryan Gabriel Elias
- Robyn Elmore
- James B Entz
- Erick Esmenjaud D.D.S. Inc
- Lorraine Espano
All providers in Bloomington, CA · Addiction (Substance Use Disorder) Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2020. 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.