Provider Demographics
NPI:1962980243
Name:ADLER, DAVID J
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22920 SIERRA TRL
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7804
Mailing Address - Country:US
Mailing Address - Phone:951-216-5765
Mailing Address - Fax:
Practice Address - Street 1:22920 SIERRA TRL
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7804
Practice Address - Country:US
Practice Address - Phone:951-216-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician