Healthcare Provider Details

I. General information

NPI: 1699589978
Provider Name (Legal Business Name): MRS. ANDREFE RECTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 BLOSSOM WAY
CHERRYLAND CA
94541-1948
US

IV. Provider business mailing address

539 NILES CMN
FREMONT CA
94536-2687
US

V. Phone/Fax

Practice location:
  • Phone: 510-315-0310
  • Fax:
Mailing address:
  • Phone: 510-676-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number696602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: