Provider Demographics
NPI:1740838622
Name:WARD, ANDREA A (ASSOCIATE DEGREE)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:WARD
Suffix:
Gender:F
Credentials:ASSOCIATE DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 TERRA VISTA PKWY APT 111
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6350
Mailing Address - Country:US
Mailing Address - Phone:225-892-4308
Mailing Address - Fax:
Practice Address - Street 1:10935 TERRA VISTA PKWY APT 111
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6350
Practice Address - Country:US
Practice Address - Phone:225-892-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty