Provider Demographics
NPI:1457187320
Name:TRAYNHAM, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:TRAYNHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9381 E STOCKTON BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5070
Mailing Address - Country:US
Mailing Address - Phone:916-307-7852
Mailing Address - Fax:
Practice Address - Street 1:4500 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-3022
Practice Address - Country:US
Practice Address - Phone:323-612-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Yes251S00000XAgenciesCommunity/Behavioral Health