Provider Demographics
NPI:1427614767
Name:ARREDONDO, CHANDRA LOU (R1333500119)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:LOU
Last Name:ARREDONDO
Suffix:
Gender:F
Credentials:R1333500119
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E 8TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2872
Mailing Address - Country:US
Mailing Address - Phone:619-232-9343
Mailing Address - Fax:
Practice Address - Street 1:1180 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3139
Practice Address - Country:US
Practice Address - Phone:619-691-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR133500119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)