Provider Demographics
NPI:1427223098
Name:VANCE, ANDREA (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6568
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-6568
Mailing Address - Country:US
Mailing Address - Phone:408-490-0308
Mailing Address - Fax:
Practice Address - Street 1:3851 CHARTER PARK DR STE U
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1385
Practice Address - Country:US
Practice Address - Phone:408-490-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17126171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist