Provider Demographics
NPI:1740308907
Name:ANDRADE, JUAN MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MIGUEL
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MD
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 830
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-0830
Mailing Address - Country:US
Mailing Address - Phone:323-588-7371
Mailing Address - Fax:323-588-1427
Practice Address - Street 1:2613 SATURN AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-588-7371
Practice Address - Fax:323-588-1427
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38298207YX0901X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38298OtherMEDICAL LICENSE
CAA38298OtherMEDICAL LICENSE
A28587Medicare UPIN
CAA38298Medicare ID - Type Unspecified