Individual
ANDRA AMORY WASKET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335-4219
(951) 643-2340
Mailing address
277 BLOOMINGTON AVE UNIT 235, RIALTO, CA 92376-6495
(909) 222-5967
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41806
CA
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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