Provider Demographics
NPI:1285232199
Name:UTECHT, RANDI R (AOD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:R
Last Name:UTECHT
Suffix:
Gender:F
Credentials:AOD
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:R
Other - Last Name:RUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:619-237-1856
Practice Address - Street 1:2136 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1102
Practice Address - Country:US
Practice Address - Phone:619-515-2588
Practice Address - Fax:619-450-6267
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA9951120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)