Healthcare Provider Details

I. General information

NPI: 1831416031
Provider Name (Legal Business Name): CHARLOTTE WEISE ANDRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD
PASADENA CA
91107-3464
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD
PASADENA CA
91107-3464
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-1613
  • Fax:
Mailing address:
  • Phone: 626-564-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: