Healthcare Provider Details

I. General information

NPI: 1154574671
Provider Name (Legal Business Name): ANDRIE SISMONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDRIE SISMONDO

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WILLOW PASS RD STE 600
CONCORD CA
94520-5292
US

IV. Provider business mailing address

7155 MISSION GORGE RD
SAN DIEGO CA
92120-1130
US

V. Phone/Fax

Practice location:
  • Phone: 925-532-3510
  • Fax:
Mailing address:
  • Phone: 858-300-0460
  • Fax: 858-300-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW107553
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: