David M Pardue, RADT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Campo, CA
NPI 1831725779 · NPPES record last updated Mar 22, 2020
Key facts
- NPI
- 1831725779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- R1368151019 (CA)
- Practice address
- 1777 Buckman Springs Rd
Campo, CA 91906-2022 - Phone
- (619) 478-5696
- NPI assigned
- Mar 22, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| R1368151019 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Diego Freedom Ranch, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1368151019 | CA | Yes |
Addresses
Primary practice location
1777 Buckman Springs Rd
Campo, CA 91906-2022
Mailing address
1777 Buckman Springs Rd
Campo, CA 91906-2022
Phone (619) 478-5696
Other providers in Campo, CA
- Garikai Moyo
- Timothy Nelson
- Hai Ho Nguyen
- James Francis Nourie
- Daniel Ochoa
- Steven Matthew Perea
- Kyle Porter
- Carlos Alberto Ramirez
- Giselle Ramirez
- Ronald Reza
All providers in Campo, 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 Mar 22, 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.