Healthcare Provider Details

I. General information

NPI: 1376707992
Provider Name (Legal Business Name): ANDREA GABRIELE HARGROVE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2008
Last Update Date: 07/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 LAUREL AVE
REDLANDS CA
92373-4838
US

IV. Provider business mailing address

28413 MERRIDY AVE
HIGHLAND CA
92346-3856
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-4701
  • Fax: 909-792-6397
Mailing address:
  • Phone: 909-425-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number376614
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number376614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: