Healthcare Provider Details

I. General information

NPI: 1922357185
Provider Name (Legal Business Name): ARLENE GUADALUPE ANDRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 ZANKER RD
SAN JOSE CA
95134-2130
US

IV. Provider business mailing address

4695 ALUM ROCK AVE
SAN JOSE CA
95127-2402
US

V. Phone/Fax

Practice location:
  • Phone: 408-325-5120
  • Fax: 408-944-9114
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: