Basic Information
Provider Information
NPI: 1003010059
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARDO
FirstName: ANDREA
MiddleName: CATALINA
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11175 CAMPUS ST
Address2: ROOM A1120C
City: LOMA LINDA
State: CA
PostalCode: 923501700
CountryCode: US
TelephoneNumber: 9095588242
FaxNumber: 9098351780
Practice Location
Address1: 225 E CHICAGO AVE # 51
Address2:  
City: CHICAGO
State: IL
PostalCode: 606112991
CountryCode: US
TelephoneNumber: 3122273550
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2007
LastUpdateDate: 02/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0402XA119728CAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
2084N0402X036.138406ILY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology

ID Information
IDTypeStateIssuerDescription
A11972801CACALIFORNIA LICENSEOTHER
FP309810901 DEAOTHER


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