Healthcare Provider Details

I. General information

NPI: 1871202648
Provider Name (Legal Business Name): CLARISSA JUDITH ARIAS ANDRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH HILL AVE SUITE 100
PASADENA CA
91106
US

IV. Provider business mailing address

50 NORTH HILL AVE SUITE 100
PASADENA CA
91106
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: