Basic Information
| Provider Information | |||||||||
| NPI: | 1184774580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDRADE | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | EILEEN KEA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PHILLIPS | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | EILEEN KEA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19431 NEWHOUSE ST | ||||||||
| Address2: | |||||||||
| City: | CANYON COUNTRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913512783 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1240 N MISSION RD | ||||||||
| Address2: | ROOM L-902 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232263691 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A89016 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD-14035 | HI | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.