Healthcare Provider Details

I. General information

NPI: 1518462688
Provider Name (Legal Business Name): ANDREA FRANCESCA MARCIAL MS, ATC, NREMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 MAGNOLIA AVE
RIVERSIDE CA
92504-3206
US

IV. Provider business mailing address

21343 CONRADI AVE
TORRANCE CA
90502-1922
US

V. Phone/Fax

Practice location:
  • Phone: 877-815-8287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE117789
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000034703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: