Provider Demographics
NPI:1215413588
Name:FREITAS, RICHARD C (RADT-1)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:FREITAS
Suffix:
Gender:M
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 A STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2111
Mailing Address - Country:US
Mailing Address - Phone:619-235-0592
Mailing Address - Fax:619-235-0593
Practice Address - Street 1:2516 A STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2111
Practice Address - Country:US
Practice Address - Phone:619-235-0592
Practice Address - Fax:619-235-0593
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)