Provider Demographics
NPI:1417186396
Name:ANDRADE, MANUEL
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8204
Mailing Address - Country:US
Mailing Address - Phone:904-356-1612
Mailing Address - Fax:904-356-7095
Practice Address - Street 1:2715 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8204
Practice Address - Country:US
Practice Address - Phone:904-356-1612
Practice Address - Fax:904-356-7095
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management