Healthcare Provider Details

I. General information

NPI: 1962349076
Provider Name (Legal Business Name): ANDREW STRATTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PARK AVE
ALISO VIEJO CA
92656-2847
US

IV. Provider business mailing address

33122 VALLE RD
SAN JUAN CAPISTRANO CA
92675-4859
US

V. Phone/Fax

Practice location:
  • Phone: 949-831-2622
  • Fax:
Mailing address:
  • Phone: 949-234-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220119006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: