Healthcare Provider Details

I. General information

NPI: 1114591054
Provider Name (Legal Business Name): MR. ALEJANDRO ANDRADE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S LOVERS LN
VISALIA CA
93292-5249
US

IV. Provider business mailing address

1223 S LOVERS LN
VISALIA CA
93292-5249
US

V. Phone/Fax

Practice location:
  • Phone: 559-931-1001
  • Fax:
Mailing address:
  • Phone: 559-931-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160296
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: