Provider Demographics
NPI:1841466646
Name:KURTZ, ANDREA (LVN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35373 SAGUARO DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8724
Mailing Address - Country:US
Mailing Address - Phone:310-339-5565
Mailing Address - Fax:951-246-4725
Practice Address - Street 1:35373 SAGUARO DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8724
Practice Address - Country:US
Practice Address - Phone:310-339-5565
Practice Address - Fax:951-246-4725
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health