Provider Demographics
NPI:1174044424
Name:ANDRADE, CYNTHIA EDITH (BS, ATC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:EDITH
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S HULBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2408
Mailing Address - Country:US
Mailing Address - Phone:559-217-3943
Mailing Address - Fax:
Practice Address - Street 1:2309 TULARE ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2287
Practice Address - Country:US
Practice Address - Phone:559-457-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program