Provider Demographics
NPI:1952441529
Name:LISA D'ANDRADE
Entity Type:Organization
Organization Name:LISA D'ANDRADE
Other - Org Name:HAND THERAPY CENTER OF THE SOUTH BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:D'ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:310-371-5111
Mailing Address - Street 1:19000 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1517
Mailing Address - Country:US
Mailing Address - Phone:310-371-5111
Mailing Address - Fax:310-371-8528
Practice Address - Street 1:19000 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1517
Practice Address - Country:US
Practice Address - Phone:310-371-5111
Practice Address - Fax:310-371-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6041990001Medicare NSC