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General NPI Number Information
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NPI Number | 1235471962
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Entity Type | Individual
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Provider Name | DR. ANDREA M KORNBAU
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Gender | Female
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 1000 W CARSON ST BOX 8
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City | TORRANCE
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State | CA
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Zip | 90502
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Country | US
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Telephone | 310-222-3137
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST STE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1844
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Country | US
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Telephone | 510-350-2600
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A131472
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License Number State | CA
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