Healthcare Provider Details

I. General information

NPI: 1316127566
Provider Name (Legal Business Name): GRACIE ALDERETE ANDRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 GABILAN DR
SOLEDAD CA
93960-3550
US

IV. Provider business mailing address

1270 NATIVIDAD RD RM 200
SALINAS CA
93906-3122
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8740
  • Fax: 831-678-5130
Mailing address:
  • Phone: 831-755-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: