Healthcare Provider Details

I. General information

NPI: 1396600425
Provider Name (Legal Business Name): DANTE ANDRES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

IV. Provider business mailing address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

V. Phone/Fax

Practice location:
  • Phone: 831-800-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95038374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: