Provider Demographics
NPI:1669862439
Name:ANDREA S. HANCOCK
Entity Type:Organization
Organization Name:ANDREA S. HANCOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF-EMPLOYED
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:510-378-7852
Mailing Address - Street 1:40231 HACIENDA CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3607
Mailing Address - Country:US
Mailing Address - Phone:510-378-7852
Mailing Address - Fax:
Practice Address - Street 1:40231 HACIENDA CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3607
Practice Address - Country:US
Practice Address - Phone:510-378-7852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6071261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation