Healthcare Provider Details

I. General information

NPI: 1922500560
Provider Name (Legal Business Name): ANDY HO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E HOLT AVE STE B
POMONA CA
91767
US

IV. Provider business mailing address

24217 SYLVAN GLEN RD
DIAMOND BAR CA
91765-4502
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-2521
  • Fax:
Mailing address:
  • Phone: 626-532-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: