Provider Demographics
NPI:1497055321
Name:FARIA, ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:FARIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:FARIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1829 OHLONE STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:209-604-9202
Mailing Address - Fax:
Practice Address - Street 1:428 ALICE ST STE 110
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4326
Practice Address - Country:US
Practice Address - Phone:510-748-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor