Healthcare Provider Details

I. General information

NPI: 1225680010
Provider Name (Legal Business Name): ANDREA MARIA GORRONDONA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 02/08/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HOLLY LN
SALINA KS
67401-8452
US

IV. Provider business mailing address

400 S SANTA FE AVE
SALINA KS
67401-4144
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-7396
  • Fax:
Mailing address:
  • Phone: 785-452-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number03271
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: