Healthcare Provider Details

I. General information

NPI: 1033840004
Provider Name (Legal Business Name): ANDREW J DREY-MULARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 PIERCE ST SPC 241
RIVERSIDE CA
92505-3825
US

IV. Provider business mailing address

4000 PIERCE ST SPC 241
RIVERSIDE CA
92505-3825
US

V. Phone/Fax

Practice location:
  • Phone: 951-463-8561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: