Individual
ANDY BA LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11301 WILSHIRE BLVD, LOS ANGELES, CA 90073-1003
(310) 478-3711
Mailing address
131 W TILLER AVE, ANAHEIM, CA 92802-4834
(817) 798-2675
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/01/2022
Last updated
04/01/2022
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