Organization
AGAVE MEDICAL FL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DOMINIC SCAHILL MD (CEO)
(510) 871-5025
Entity
Organization
Contact information
Practice address
16397 ROAD 37, MADERA, CA 93636-8224
(510) 871-5025
Mailing address
16397 ROAD 37, MADERA, CA 93636-8224
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TH0004X
Health Psychologist
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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