Provider Demographics
NPI:1770006157
Name:REW, GEORGE ALBERT (CERTIFICATION)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALBERT
Last Name:REW
Suffix:
Gender:M
Credentials:CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5414
Mailing Address - Country:US
Mailing Address - Phone:619-619-3597
Mailing Address - Fax:
Practice Address - Street 1:1733 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5414
Practice Address - Country:US
Practice Address - Phone:619-634-9336
Practice Address - Fax:619-634-9336
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADDC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)