Organization
DEANDREA A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ANTHONY DEANDREA MD (PRESIDENT)
(818) 552-5000
Entity
Organization
Contact information
Practice address
1101 N PACIFIC AVE STE 104, GLENDALE, CA 91202-4313
(818) 552-5000
(818) 552-2959
Mailing address
1101 N PACIFIC AVE STE 104, GLENDALE, CA 91202-4313
(818) 552-5000
(818) 552-2959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G74640
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G74640
LICENSE
CA
Enumeration date
07/06/2006
Last updated
03/07/2023
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