Basic Information
| Provider Information | |||||||||
| NPI: | 1437295938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEANDREA | ||||||||
| FirstName: | G. | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 748157 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900748157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895250 | ||||||||
| FaxNumber: | 5417895538 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895710 | ||||||||
| FaxNumber: | 5417895711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD00026727 | WA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | ME72061 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | MD00026727 | WA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 2084S0012X | ME72061 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 2084N0400X | MD156525 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | MD156525 | OR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
No ID Information.