Healthcare Provider Details

I. General information

NPI: 1356960710
Provider Name (Legal Business Name): ANDREW SPELLER RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 HEDGES DR
CORONA CA
92880-7331
US

IV. Provider business mailing address

921 HEDGES DR
CORONA CA
92880-7331
US

V. Phone/Fax

Practice location:
  • Phone: 714-818-3753
  • Fax:
Mailing address:
  • Phone: 714-818-3753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number40382
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number40382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: