Healthcare Provider Details

I. General information

NPI: 1891613378
Provider Name (Legal Business Name): LISA MARIE ANDRADE CNA/HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 COLORADO AVE
RIVERSIDE CA
92503-2104
US

IV. Provider business mailing address

8701 COLORADO AVE
RIVERSIDE CA
92503-2104
US

V. Phone/Fax

Practice location:
  • Phone: 760-407-5506
  • Fax:
Mailing address:
  • Phone: 760-407-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00376416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: