Provider Demographics
NPI:1962184440
Name:KAMRAVA, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:KAMRAVA
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 1:506 PIEDMONT # 506
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2844
Mailing Address - Country:US
Mailing Address - Phone:949-310-1027
Mailing Address - Fax:
Practice Address - Street 1:506 PIEDMONT # 506
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-2844
Practice Address - Country:US
Practice Address - Phone:949-310-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst