Provider Demographics
NPI:1932361003
Name:MCCOMAS, ANDREA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:MCCOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:CONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 RED PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7750
Mailing Address - Country:US
Mailing Address - Phone:707-365-7626
Mailing Address - Fax:
Practice Address - Street 1:584 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2779
Practice Address - Country:US
Practice Address - Phone:530-661-3213
Practice Address - Fax:530-661-3027
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker