MR. MICHAEL DEREK WATERS (NPI# 1316505100) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316505100 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL DEREK WATERS |
| Credential | RADT |
| Practice Address |
1777 Buckman Springs Rd Campo CA 91906-2022 |
| Practice Telephone | 6194785696 |
| Practice Fax Number | 6194782404 |
| Mailing Telephone | 6194785696 |
| Mailing Fax Number | 6194782404 |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
R1349930619 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619447380 | Michael Waters | Internal Medicine | 10 Samuel Dr, Washington, PA 15301-3206 | 2018-11-26 |
| 1316147457 | Michael Waters | Military Health Care Provider | 14900 Park Central Road, Naval Support Facility, Thurmont, MD 21788 | 2007-07-18 |
| 1629140561 | Michael Farris Waters | Specialist | 240 W Thomas Rd # 403, Phoenix, AZ 85013 | 2006-11-15 |
| 1912948084 | Michael Brandon Waters | Physical Therapist | 247 Oak St Extension, Suite 145, Forest City, NC 28043-3585 | 2006-06-09 |
| 1417915547 | Michael G Waters | Family Medicine | 4944 Greensboro Rd, Ridgeway, VA 24148-3390 | 2006-05-01 |
| 1275596538 | Michael G Waters | Urology | 2900 Acme Brick Plz, Fort Worth, TX 76109-4123 | 2006-04-08 |
| 1811965908 | Michael L Waters | Family Medicine | 13001 Atlantic Blvd, Suite 100, Jacksonville, FL 32225-3123 | 2006-03-14 |
| 1861469512 | Michael Alan Waters | Specialist | 309 S. Medford Dr., Lufkin, TX 75901-5245 | 2006-03-01 |
| 1710540786 | Michael Richard Waters | Student in an Organized Health Care Education/Training Program | 500 J Clyde Morris Blvd, Newport News, VA 23601-1929 | 2019-04-16 |
| 1962974220 | Michael Waters | Licensed Practical Nurse | 7248 Elmwood Ave, Philadelphia, PA 19142-1533 | 2018-12-27 |
| Street Address |
1777 BUCKMAN SPRINGS RD |
| City | CAMPO |
| State | CA |
| Zip Code | 91906-2022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093937591 | San Diego Freedom Ranch, Inc. | Substance Abuse Rehabilitation Facility | 1777 Buckman Springs Rd, Campo, CA 91906 | 2007-05-03 |
| 1518577493 | Billy Don Wilson | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-08-05 |
| 1043820202 | Marco Martinez | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-08-03 |
| 1831725779 | David M Pardue | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-03-22 |
| 1124686910 | Kyle Andrew Jordan | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-06-05 |
| 1699234161 | Billy Darrell Lockett | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-14 |
| 1568921112 | James Francis Nourie | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| 1467911016 | Richard Adali Shaplin | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| 1861951410 | Roland Joseph Lebel | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| 1942769591 | John Francis Dehamm | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316424351 | Jr Ranch | Substance Abuse Rehabilitation Facility | 1765 Buckman Springs Rd, Campo, CA 91906 | 2018-07-23 |
| 1336592740 | Mountain Health & Community Services, Inc. | Clinic/Center | 1388 Buckman Springs Road, Campo, CA 91906 | 2016-07-20 |
| 1932572385 | Joshua Knutson | Marriage & Family Therapist | 976 Sheridan Rd, Campo, CA 91906 | 2015-11-06 |
| 1760603740 | Linda Rae Anderson | Acupuncturist | 33446 Hwy 94, Campo, CA 91906 | 2007-05-01 |
| 1407887227 | Jay Mark Cool | Physician Assistant | 31115 Highway 94, Campo, CA 91906 | 2006-07-06 |
| 1982658142 | Mountain Health & Community Services, Inc. | Clinic/Center | 1388 Buckman Springs Rd, Campo, CA 91906-2028 | 2006-05-20 |
| 1174164719 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 1388 Buckman Springs Rd, Campo, CA 91906-2028 | 2019-10-04 |
| 1417026758 | Southern Indian Health Council Inc | Pharmacy | 36350 Church Rd, Campo, CA 91906-2715 | 2006-11-08 |
| 1922090885 | Southern Indian Health Council Inc | Clinic/Center | 36350 Church Road, Campo, CA 91906-2715 | 2005-08-17 |
| 1982957361 | Abby Jane-marie Cordova | Marriage & Family Therapist | 36350 Church Rd, Campo, CA 91906-2715 | 2012-10-22 |
| Find all providers in zip 91906 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275775751 | Roxanne Marie Hagan | Counselor | 957 Forest Gate Rd, Campo, CA 91906-3101 | 2009-03-31 |
| 1518577493 | Billy Don Wilson | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-08-05 |
| 1043820202 | Marco Martinez | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-08-03 |
| 1831725779 | David M Pardue | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-03-22 |
| 1124686910 | Kyle Andrew Jordan | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-06-05 |
| 1699234161 | Billy Darrell Lockett | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-14 |
| 1568921112 | James Francis Nourie | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| 1467911016 | Richard Adali Shaplin | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| 1861951410 | Roland Joseph Lebel | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
| 1942769591 | John Francis Dehamm | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-03-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.