Provider Demographics
NPI:1841580339
Name:DE ANDRADE FILHO, PEDRO ALCANTARA (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALCANTARA
Last Name:DE ANDRADE FILHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:ALCANTARA DE
Other - Last Name:ANDRADE FILHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11175 CAMPUS ST STE 11120
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:909-558-0440
Mailing Address - Fax:
Practice Address - Street 1:11175 CAMPUS ST STE 11120
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1700
Practice Address - Country:US
Practice Address - Phone:909-558-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126819207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology