Basic Information
Provider Information | |||||||||
NPI: | 1679580831 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALDRETE | ||||||||
FirstName: | ANDRES | ||||||||
MiddleName: | MARTIN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX HH | ||||||||
Address2: | BUSINESS DEVELOPMENT & CONTRACTING | ||||||||
City: | MONTEREY | ||||||||
State: | CA | ||||||||
PostalCode: | 93942 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8316254945 | ||||||||
FaxNumber: | 8316254764 | ||||||||
Practice Location | |||||||||
Address1: | 23625 HOLMAN HWY | ||||||||
Address2: |   | ||||||||
City: | MONTEREY | ||||||||
State: | CA | ||||||||
PostalCode: | 939405902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8316245311 | ||||||||
FaxNumber: | 8316254948 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2006 | ||||||||
LastUpdateDate: | 07/29/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G78430 | CA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 00G784300 | 01 | CA | BLUE SHIELD | OTHER | 930086627 | 01 | CA | RAILROAD | OTHER |