Provider Demographics
NPI:1780998427
Name:HUMPHRIES, ANDREA (CMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 SPORTS ARENA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4525
Mailing Address - Country:US
Mailing Address - Phone:858-531-8011
Mailing Address - Fax:
Practice Address - Street 1:3156 SPORTS ARENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4525
Practice Address - Country:US
Practice Address - Phone:858-531-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2010021440175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath