Provider Demographics
NPI:1164900148
Name:ANDRADA, JASON (RN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:ANDRADA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E 218TH PL
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3001
Mailing Address - Country:US
Mailing Address - Phone:562-330-9284
Mailing Address - Fax:
Practice Address - Street 1:1149 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4321
Practice Address - Country:US
Practice Address - Phone:310-851-4705
Practice Address - Fax:310-851-4719
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95134096163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse