Provider Demographics
NPI:1841402583
Name:PURCELL, ANDREA (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 ORANGE AVE
Mailing Address - Street 2:PORTAL TO HEALING
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-722-6797
Mailing Address - Fax:949-722-7291
Practice Address - Street 1:1770 ORANGE AVE
Practice Address - Street 2:PORTAL TO HEALING
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-722-6797
Practice Address - Fax:949-722-7291
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND 51207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine