Provider Demographics
NPI:1134473812
Name:ANDRADES, JOSE C
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:C
Last Name:ANDRADES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H41 CALLE 4
Mailing Address - Street 2:MONTE VERDE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3517
Mailing Address - Country:US
Mailing Address - Phone:787-944-5395
Mailing Address - Fax:
Practice Address - Street 1:H41 CALLE 4
Practice Address - Street 2:MONTE VERDE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3517
Practice Address - Country:US
Practice Address - Phone:787-944-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical