Healthcare Provider Details

I. General information

NPI: 1902223183
Provider Name (Legal Business Name): ADA ANDRADE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 RALSTON ST STE 103
VENTURA CA
93003-6042
US

IV. Provider business mailing address

5450 RALSTON ST STE 103
VENTURA CA
93003-6042
US

V. Phone/Fax

Practice location:
  • Phone: 805-539-7191
  • Fax:
Mailing address:
  • Phone: 805-539-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number118854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: