Provider Demographics
NPI:1740620483
Name:VIDAURRE, ANDREA Y (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:Y
Last Name:VIDAURRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12062 VALLEY VIEW ST
Mailing Address - Street 2:SUITE 133
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1737
Mailing Address - Country:US
Mailing Address - Phone:714-906-3933
Mailing Address - Fax:714-892-9171
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 133
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-906-3933
Practice Address - Fax:714-892-9171
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor