Provider Demographics
NPI:1740325620
Name:D'ANDRIA, THERESA IRENE (LAC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:IRENE
Last Name:D'ANDRIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 S MYRTLE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5103
Mailing Address - Country:US
Mailing Address - Phone:626-359-1558
Mailing Address - Fax:626-357-5301
Practice Address - Street 1:525 S MYRTLE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5103
Practice Address - Country:US
Practice Address - Phone:626-359-1558
Practice Address - Fax:626-357-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 7047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist