Healthcare Provider Details

I. General information

NPI: 1942792007
Provider Name (Legal Business Name): ANDREA LEIGH SILVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE BLDG F
CERES CA
95307-4562
US

IV. Provider business mailing address

705 ENSLEN AVE
MODESTO CA
95354-0118
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7466
  • Fax:
Mailing address:
  • Phone: 559-281-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number290588
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA183915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: