Provider Demographics
NPI:1790796217
Name:PARMELEE, ANDREA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:PARMELEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 LOMA VISTA RD
Mailing Address - Street 2:STE C
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3086
Mailing Address - Country:US
Mailing Address - Phone:805-642-8107
Mailing Address - Fax:805-642-0964
Practice Address - Street 1:3442 LOMA VISTA RD
Practice Address - Street 2:STE C
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3086
Practice Address - Country:US
Practice Address - Phone:805-642-8107
Practice Address - Fax:805-642-0964
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51422207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51988Medicare UPIN
CAG51422Medicare ID - Type UnspecifiedMEDICARE