Provider Demographics
NPI:1144949769
Name:ANDRADE, MIRNA (PSS)
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E VALENCIA AVE APT E
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2569
Mailing Address - Country:US
Mailing Address - Phone:562-940-5745
Mailing Address - Fax:
Practice Address - Street 1:2085 RUSTIN AVE # 1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-955-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist