MEDICARE: ANDREA ELGRICHI

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	235Z00000X	Speech-Language Pathologist	10537	CA
2	235Z00000X	Speech-Language Pathologist	46253	CA

General Provider Information

NPI Number	:	1043668122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ELGRICHI

Provider Business Mailing Address
First Line	:	128 N SWALL DR APT 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6807
Country	:	US
Telephone Number	:	310-780-1286
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 N SWALL DR APT 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6807
Country	:	US
Telephone Number	:	310-780-1286
Fax Number	:

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

Provider Enumeration Date	:	05/30/2016
Last Update Date	:	11/19/2020

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Directions to “ ANDREA ELGRICHI ” Practice Location

Language	Start Address	Practice Location

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