Organization
COMMUNITY INTERVENTION ASSOCIAGTES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTAVO ALBERT RODRIGUEZ LISAC (CLINICAL LIAISON)
(928) 376-0026
Entity
Organization
Contact information
Practice address
3802 W 16TH ST, YUMA, AZ 85364-4107
(928) 376-0026
(928) 782-2298
Mailing address
3802 W 16TH ST, YUMA, AZ 85364-4107
(928) 376-0026
(928) 782-2298
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-1257
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
913922
—
AZ
Enumeration date
12/14/2006
Last updated
08/22/2020
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