Healthcare Provider Details

I. General information

NPI: 1831773530
Provider Name (Legal Business Name): ANDREA CRAGOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 545
MISSION VIEJO CA
92691-8030
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 545
MISSION VIEJO CA
92691-8030
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA181837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: