Provider Demographics
NPI:1326076688
Name:MALLET-REECE, ANDREA C (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:MALLET-REECE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 S AZUSA AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748
Mailing Address - Country:US
Mailing Address - Phone:626-913-1665
Mailing Address - Fax:626-964-1788
Practice Address - Street 1:1850 S AZUSA AVE STE 20
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6827
Practice Address - Country:US
Practice Address - Phone:626-913-1665
Practice Address - Fax:626-964-1788
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG464762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8705EOtherGROUP PTAN
00G464760OtherRENDERING NUMBER
CAWG46476HOtherINDIVIDUAL PTAN