Provider Demographics
NPI:1063006146
Name:POP, ANDREEA
Entity Type:Individual
Prefix:
First Name:ANDREEA
Middle Name:
Last Name:POP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 SHERMAN WAY UNIT 200
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2167
Mailing Address - Country:US
Mailing Address - Phone:714-232-3914
Mailing Address - Fax:626-683-8819
Practice Address - Street 1:1359 VALENCIA AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3532
Practice Address - Country:US
Practice Address - Phone:714-232-3914
Practice Address - Fax:626-683-8819
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306003973310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility