Healthcare Provider Details

I. General information

NPI: 1497569693
Provider Name (Legal Business Name): ANDREA RACHELLE WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S FULLER AVE
LOS ANGELES CA
90036-5451
US

IV. Provider business mailing address

5850 W 3RD ST STE E #1141
LOS ANGELES CA
90036-2836
US

V. Phone/Fax

Practice location:
  • Phone: 415-867-3903
  • Fax:
Mailing address:
  • Phone: 415-867-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: