Healthcare Provider Details

I. General information

NPI: 1740308907
Provider Name (Legal Business Name): JUAN MIGUEL ANDRADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 SATURN AVENUE
HUNTINGTON PARK CA
90255
US

IV. Provider business mailing address

PO BOX 830
ALHAMBRA CA
91802-0830
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-7371
  • Fax: 323-588-1427
Mailing address:
  • Phone: 323-588-7371
  • Fax: 323-588-1427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA38298
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA38298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: