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NPI Code Detail

MEDICARE: CHANEL A ANDRADE LMT

MEDICARE: CHANEL A ANDRADE LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist2391-0CA

General Provider Information

NPI Number : 1609594498
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANEL A ANDRADE LMT
Provider Business Mailing Address
First Line : 5611 SAINT ANN AVE
Second Line :
City : CYPRESS
State : CA
Zip : 90630-2325
Country : US
Telephone Number : 714-915-3620
Fax Number :
Provider Business Practice Location Address
First Line : 5611 SAINT ANN AVE
Second Line :
City : CYPRESS
State : CA
Zip : 90630-2325
Country : US
Telephone Number : 714-915-3620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2022
Last Update Date : 08/17/2022

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Directions to “ CHANEL A ANDRADE LMT” Practice Location

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