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General NPI Number Information
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NPI Number | 1134380330
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Entity Type | Individual
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Provider Name | ANDREA PAOLA PASSALACQUA DO
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Gender | Female
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 886 W FOOTHILL BLVD STE G
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City | UPLAND
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State | CA
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Zip | 91786-3780
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Country | US
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Telephone | 909-949-6500
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Fax | 909-946-1133
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Provider Business Mailing Address
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Address Line | 886 W FOOTHILL BLVD STE G
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City | UPLAND
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State | CA
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Zip | 91786-3780
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Country | US
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Telephone | 909-949-6500
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Fax | 909-946-1133
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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 | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 20A8985
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License Number State | CA
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