Healthcare Provider Details

I. General information

NPI: 1780763581
Provider Name (Legal Business Name): ANDREA ARISTIZABAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD
INDIANAPOLIS IN
46260-5927
US

IV. Provider business mailing address

9588 VALPARAISO CT
INDIANAPOLIS IN
46268-1130
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number11010870A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: