Provider Demographics
NPI:1699718551
Name:DEANDREA, RICHARD A (MD, ND)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:DEANDREA
Suffix:
Gender:M
Credentials:MD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 W OLYMPIC BLVD
Mailing Address - Street 2:2201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2883
Mailing Address - Country:US
Mailing Address - Phone:213-383-7030
Mailing Address - Fax:213-383-7031
Practice Address - Street 1:2681 W OLYMPIC BLVD
Practice Address - Street 2:2201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2883
Practice Address - Country:US
Practice Address - Phone:213-383-7030
Practice Address - Fax:213-383-7031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine