Basic Information
Provider Information
NPI: 1598878241
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUPREY
FirstName: ANDREW
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: RTC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3801 MIRANDA AVENUE
Address2: 11K PALO ALTO
City: PALO ALTO
State: CA
PostalCode: 94304
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber:  
Practice Location
Address1: 3801 MIRANDA AVE
Address2: 11K PALO ALTO
City: PALO ALTO
State: CA
PostalCode: 943041207
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/16/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225800000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist 

No ID Information.


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