Provider Demographics
NPI:1851559462
Name:ANDREASEN, TROY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:JAMES
Last Name:ANDREASEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E CONCOURS ST
Mailing Address - Street 2:STE #3
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764
Mailing Address - Country:US
Mailing Address - Phone:909-481-7500
Mailing Address - Fax:909-481-1857
Practice Address - Street 1:3333 E CONCOURS ST
Practice Address - Street 2:STE #3
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-481-7500
Practice Address - Fax:909-481-1857
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61879OtherMEDICAL BOARD OF CALIFORNIA