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NPI Code Detail

MEDICARE: DR. MIRIAM MEDLIN ANDRADE PSY.D

MEDICARE: DR. MIRIAM MEDLIN ANDRADE PSY.D
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
1103T00000XPsychologistRPS2006016CA
2103TC0700XClinical PsychologistPSY23089CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19555OTHERCASF CLINICIAN BILLING ID

General Provider Information

NPI Number : 1073684684
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIRIAM MEDLIN ANDRADE PSY.D
Provider Business Mailing Address
First Line : 433 TURNER DR
Second Line :
City : BENICIA
State : CA
Zip : 94510-1417
Country : US
Telephone Number : 415-860-3406
Fax Number :
Provider Business Practice Location Address
First Line : 1421 BRODERICK ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-3304
Country : US
Telephone Number : 415-292-1760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 05/31/2019

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