Individual
ANDREA HISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1310 W STEWART DR STE 410, ORANGE, CA 92868-3855
(714) 538-8549
Mailing address
815 SEAGULL LN APT DS203, NEWPORT BEACH, CA 92663-6075
(765) 635-6024
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000033167
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2016
Last updated
02/20/2024
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