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General NPI Number Information
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NPI Number | 1437783412
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Entity Type | Organization
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Legal Business Name | ANDREA DESTORIES M.D P.C.
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 59 DAMONTE RANCH PKWY STE B577
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City | RENO
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State | NV
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Zip | 89521-1907
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Country | US
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Telephone | 504-432-2727
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Fax | 202-540-1917
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Provider Business Mailing Address
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Address Line | 59 DAMONTE RANCH PKWY STE B577
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City | RENO
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State | NV
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Zip | 89521-1907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREA L DESTORIES
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Credential | MD
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Telephone | 504-432-2727
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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 |
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License Number State |
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