Provider Demographics
NPI:1225002710
Name:ANDROY, LAURA S (PAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:ANDROY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68860 PEREZ RD STE J
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7248
Mailing Address - Country:US
Mailing Address - Phone:760-328-4499
Mailing Address - Fax:760-328-1050
Practice Address - Street 1:71777 SAN JACINTO DR STE 101
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4457
Practice Address - Country:US
Practice Address - Phone:760-776-8692
Practice Address - Fax:760-776-8418
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S89624Medicare UPIN