Provider Demographics
NPI:1407368988
Name:PALLARES, ANDREA CHRISTINE (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:PALLARES
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CHRISTINE
Other - Last Name:HARTNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3219
Mailing Address - Country:US
Mailing Address - Phone:714-456-2986
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S BLDG 29
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-880-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty