Provider Demographics
NPI:1093159493
Name:ANDRADE, RIA ROWENA (MD)
Entity Type:Individual
Prefix:DR
First Name:RIA
Middle Name:ROWENA
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S IDAHO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6047
Mailing Address - Country:US
Mailing Address - Phone:562-690-0400
Mailing Address - Fax:562-690-3182
Practice Address - Street 1:501 S IDAHO ST STE 100
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6047
Practice Address - Country:US
Practice Address - Phone:562-690-0400
Practice Address - Fax:562-690-3182
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134344207QA0505X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program