Basic Information
| Provider Information | |||||||||
| NPI: | 1306313192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN RY | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 RANA | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926881501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497095120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24451 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498374500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2018 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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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 | 363LA2100X | 95009896 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.