Provider Demographics
NPI:1194897280
Name:REDICK, ANDRE FAHAMIVU
Entity type:Individual
Prefix:PROF
First Name:ANDRE
Middle Name:FAHAMIVU
Last Name:REDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1710
Mailing Address - Country:US
Mailing Address - Phone:805-692-4821
Mailing Address - Fax:805-692-4841
Practice Address - Street 1:4500 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1710
Practice Address - Country:US
Practice Address - Phone:805-692-4821
Practice Address - Fax:805-692-4841
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator