Provider Demographics
NPI:1295229086
Name:ANDRA MEDICAL GROUP
Entity Type:Organization
Organization Name:ANDRA MEDICAL GROUP
Other - Org Name:THE ANDRA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-876-1027
Mailing Address - Street 1:3831 HUGHES AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6848
Mailing Address - Country:US
Mailing Address - Phone:310-340-7750
Mailing Address - Fax:310-876-0651
Practice Address - Street 1:3831 HUGHES AVE STE 604
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6848
Practice Address - Country:US
Practice Address - Phone:310-340-7750
Practice Address - Fax:310-876-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty