Provider Demographics
NPI:1922261395
Name:ROUGHT, ANDREA IRENE (R EEGT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:IRENE
Last Name:ROUGHT
Suffix:
Gender:F
Credentials:R EEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVINE BLVD #716
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:959-751-9790
Mailing Address - Fax:714-838-9195
Practice Address - Street 1:1100 IRVINE BLVD
Practice Address - Street 2:#716
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:959-751-9790
Practice Address - Fax:714-838-9195
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2975246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic