Provider Demographics
NPI:1104086594
Name:CHAN, ANDY (RN)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3008
Mailing Address - Country:US
Mailing Address - Phone:760-740-4215
Mailing Address - Fax:760-740-4003
Practice Address - Street 1:606 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3008
Practice Address - Country:US
Practice Address - Phone:760-740-4215
Practice Address - Fax:760-740-4003
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse