Provider Demographics
NPI:1053847764
Name:NDLELA, ANDILE ANDY (CHES)
Entity Type:Individual
Prefix:MR
First Name:ANDILE
Middle Name:ANDY
Last Name:NDLELA
Suffix:
Gender:M
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17296 SLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7585
Mailing Address - Country:US
Mailing Address - Phone:909-609-3000
Mailing Address - Fax:909-609-3015
Practice Address - Street 1:17296 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7585
Practice Address - Country:US
Practice Address - Phone:909-609-3000
Practice Address - Fax:909-609-3015
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACHES 5196174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator