Provider Demographics
NPI:1497502751
Name:ANDIA, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ANDIA
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 1:11752 W DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-2361
Mailing Address - Country:US
Mailing Address - Phone:623-910-4209
Mailing Address - Fax:
Practice Address - Street 1:7235 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4040
Practice Address - Country:US
Practice Address - Phone:702-791-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program