Provider Demographics
NPI:1255566337
Name:BRONZO, ANDREA (BA)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:BRONZO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:BRONZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-1195
Mailing Address - Country:US
Mailing Address - Phone:510-541-9321
Mailing Address - Fax:
Practice Address - Street 1:5349 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1416
Practice Address - Country:US
Practice Address - Phone:510-457-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26664405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional