Provider Demographics
NPI:1114289758
Name:ANDRACA, MARIUXI (MSED/BE)
Entity Type:Individual
Prefix:MS
First Name:MARIUXI
Middle Name:
Last Name:ANDRACA
Suffix:
Gender:F
Credentials:MSED/BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19633 FOOTHILL AVE
Mailing Address - Street 2:2FLOOR
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1413
Mailing Address - Country:US
Mailing Address - Phone:646-418-7413
Mailing Address - Fax:
Practice Address - Street 1:19633 FOOTHILL AVE
Practice Address - Street 2:2FLOOR
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423
Practice Address - Country:US
Practice Address - Phone:646-418-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27404OtherNYSDOH