Provider Demographics
NPI:1366725384
Name:SULSONA, ANDREA MARISOL (MA ED)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARISOL
Last Name:SULSONA
Suffix:
Gender:F
Credentials:MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1831
Mailing Address - Country:US
Mailing Address - Phone:213-385-5100
Mailing Address - Fax:323-249-0776
Practice Address - Street 1:711 S NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1831
Practice Address - Country:US
Practice Address - Phone:213-385-5100
Practice Address - Fax:323-249-0776
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator