Individual provider Active NPI

Robert William Kreiss, CADC-II, ICADC

  • Addiction (Substance Use Disorder) Counselor
  • Vista, CA
National Provider Identifier
1861930174
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
A050731118 Issued in CA
Practice address
504 W Vista Way
Vista, CA 92083-5704
Phone
(951) 434-9007
NPI assigned
Feb 7, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X A050731118 CA Primary

Addresses

Primary practice location

504 W Vista Way
Vista, CA 92083-5704

Mailing address

21132 Alameda del Monte
Wildomar, CA 92595-8541
Phone (951) 434-9007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
A050731118CAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1861930174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21132 ALAMEDA DEL MONTE",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925958541",
            "telephone_number": "951-434-9007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W VISTA WAY",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920835704",
            "telephone_number": "951-434-9007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREISS",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "credential": "CADC-II, ICADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-07",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "A050731118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.