Provider Demographics
NPI:1164760591
Name:YAMADA, ANDREA TESS (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:TESS
Last Name:YAMADA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7571 E 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2482
Mailing Address - Country:US
Mailing Address - Phone:303-594-6381
Mailing Address - Fax:
Practice Address - Street 1:5191 S YOSEMITE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3360
Practice Address - Country:US
Practice Address - Phone:303-557-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001862171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist