Provider Demographics
NPI:1700297710
Name:CISE, ANDREA CABELLO
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CABELLO
Last Name:CISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ALESSANDRA
Other - Last Name:CABELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4623 RAYBURN ST
Mailing Address - Street 2:APT 36G
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4726
Mailing Address - Country:US
Mailing Address - Phone:650-279-8011
Mailing Address - Fax:
Practice Address - Street 1:4733 W SUNSET BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6021
Practice Address - Country:US
Practice Address - Phone:323-783-1433
Practice Address - Fax:866-455-3867
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA144181207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program