MEDICARE: AUDREY DANDREA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G60885	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033101118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY DANDREA MD

Provider Business Mailing Address
First Line	:	1450 TREAT BLVD # 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:	925-952-2855
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 SAN PABLO AVE # 310
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702
Country	:	US
Telephone Number	:	925-985-5020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/02/2018

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Directions to “ AUDREY DANDREA MD” Practice Location

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