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NPI Code Detail

MEDICARE: MR. LARRY EUGENE ANDRADE II CADC II

MEDICARE: MR. LARRY EUGENE ANDRADE II CADC II
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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1207930715CA
2101YA0400XAddiction (Substance Use Disorder) CounselorA059650421CA

General Provider Information

NPI Number : 1669986626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY EUGENE ANDRADE II CADC II
Provider Business Mailing Address
First Line : 120 W SCHOOL AVE
Second Line :
City : VISALIA
State : CA
Zip : 93291-4925
Country : US
Telephone Number : 559-625-4100
Fax Number : 559-625-1970
Provider Business Practice Location Address
First Line : 120 W SCHOOL AVE
Second Line :
City : VISALIA
State : CA
Zip : 93291-4925
Country : US
Telephone Number : 559-625-4100
Fax Number : 559-625-1970
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2017
Last Update Date : 01/12/2022

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