Provider Demographics
NPI:1689274722
Name:HARDGE, SEAN ANDRE
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANDRE
Last Name:HARDGE
Suffix:
Gender:M
Credentials:
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 1814
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91788-1814
Mailing Address - Country:US
Mailing Address - Phone:909-569-7244
Mailing Address - Fax:
Practice Address - Street 1:20723 WALNUT VALLEY DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1024
Practice Address - Country:US
Practice Address - Phone:909-595-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator