Provider Demographics
NPI:1912225434
Name:MINESAKI, ANDREA MARIE (NMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:MINESAKI
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 W GRISWOLD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9125
Mailing Address - Country:US
Mailing Address - Phone:480-277-0405
Mailing Address - Fax:
Practice Address - Street 1:4140 E BASELINE RD
Practice Address - Street 2:#110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4412
Practice Address - Country:US
Practice Address - Phone:480-539-0777
Practice Address - Fax:480-539-6054
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1192175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath