1649553975 NPI number — LA ANDRES, MD PLLC

Table of content: (NPI 1649553975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649553975 NPI number — LA ANDRES, MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA ANDRES, MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649553975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15040
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85267-5040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-275-7800
Provider Business Mailing Address Fax Number:
480-758-4587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8595 E BELL RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-275-7800
Provider Business Practice Location Address Fax Number:
480-758-4587
Provider Enumeration Date:
09/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDRES
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
480-275-7800

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  40126 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)