Provider Demographics
NPI:1952055352
Name:FERNANDES DE ANDRADE, WIRIFRAN (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:WIRIFRAN
Middle Name:
Last Name:FERNANDES DE ANDRADE
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33003
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-2003
Mailing Address - Country:US
Mailing Address - Phone:619-831-1784
Mailing Address - Fax:
Practice Address - Street 1:842 WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2214
Practice Address - Country:US
Practice Address - Phone:619-831-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19317171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty