Provider Demographics
NPI:1245605369
Name:ANDRES, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ANDRES
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 1:22638 FIGUEROA ST
Mailing Address - Street 2:APT.3
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4437
Mailing Address - Country:US
Mailing Address - Phone:310-935-8229
Mailing Address - Fax:
Practice Address - Street 1:22638 FIGUEROA ST
Practice Address - Street 2:APT.3
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-4437
Practice Address - Country:US
Practice Address - Phone:310-935-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10216225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant