Healthcare Provider Details

I. General information

NPI: 1104029073
Provider Name (Legal Business Name): NORMA L ANDRONIC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 PATS RANCH RD STE G
JURUPA VALLEY CA
91752-4439
US

IV. Provider business mailing address

2744 CAPE DR
CORONA CA
92882-5764
US

V. Phone/Fax

Practice location:
  • Phone: 951-808-5881
  • Fax:
Mailing address:
  • Phone: 619-729-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53897
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: