Provider Demographics
NPI:1376000901
Name:DAGOSTARO, ANDREA DESIREE (SLPA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DESIREE
Last Name:DAGOSTARO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10716 LA TUNA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2130
Mailing Address - Country:US
Mailing Address - Phone:818-252-5863
Mailing Address - Fax:
Practice Address - Street 1:10716 LA TUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2130
Practice Address - Country:US
Practice Address - Phone:818-252-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer