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General NPI Number Information
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NPI Number | 1073684684
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Entity Type | Individual
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Provider Name | MIRIAM MEDLIN ANDRADE PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 1421 BRODERICK ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-3304
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Country | US
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Telephone | 415-292-1760
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Fax |
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Provider Business Mailing Address
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Address Line | 433 TURNER DR
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City | BENICIA
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State | CA
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Zip | 94510-1417
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Country | US
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Telephone | 415-860-3406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | RPS2006016
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23089
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License Number State | CA
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