Provider Demographics
NPI:1407210875
Name:TURNER, ANDIA H (MD)
Entity Type:Individual
Prefix:
First Name:ANDIA
Middle Name:H
Last Name:TURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDIA
Other - Middle Name:
Other - Last Name:HEYDARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 VANTIS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2677
Mailing Address - Country:US
Mailing Address - Phone:949-328-6693
Mailing Address - Fax:
Practice Address - Street 1:6833 INDIANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4223
Practice Address - Country:US
Practice Address - Phone:657-346-6319
Practice Address - Fax:951-269-4184
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1539952084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry