Individual
DR. ANDREA ELIZABETH LEE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11234 ANDERSON ST, MC 1509, LOMA LINDA, CA 92354-2804
(909) 558-4499
(909) 558-0428
Mailing address
11234 ANDERSON ST, MC 1509, LOMA LINDA, CA 92354-2804
(909) 558-4499
(909) 558-0428
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A113535
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508091257
NPI
CA
01
—
490328
MEDI-CAL DOCUMENT NUMBER
CA
01
—
A113535
CA STATE LIC
CA
Enumeration date
05/26/2009
Last updated
07/21/2022
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