Provider Demographics
NPI:1437783412
Name:ANDREA DESTORIES M.D P.C.
Entity Type:Organization
Organization Name:ANDREA DESTORIES M.D P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESTORIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-432-2727
Mailing Address - Street 1:59 DAMONTE RANCH PKWY STE B577
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59 DAMONTE RANCH PKWY STE B577
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-1907
Practice Address - Country:US
Practice Address - Phone:504-432-2727
Practice Address - Fax:202-540-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty