Provider Demographics
NPI:1932599503
Name:ANDRADE, ALEJANDRO LUNA JR
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:LUNA
Last Name:ANDRADE
Suffix:JR
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 K ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5139
Mailing Address - Country:US
Mailing Address - Phone:916-591-6630
Mailing Address - Fax:
Practice Address - Street 1:2715 K ST STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5139
Practice Address - Country:US
Practice Address - Phone:916-591-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical