Healthcare Provider Details

I. General information

NPI: 1801165162
Provider Name (Legal Business Name): PATSY ANDRADA MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16465 SIERRA LAKES PKWY STE 145
FONTANA CA
92336-1242
US

IV. Provider business mailing address

640 S SUNSET AVE STE 102
WEST COVINA CA
91790-2808
US

V. Phone/Fax

Practice location:
  • Phone: 909-725-4742
  • Fax: 909-752-9275
Mailing address:
  • Phone: 626-338-9000
  • Fax: 626-338-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17455
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number208000000X
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: