Basic Information
| Provider Information | |||||||||
| NPI: | 1669550463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | BRET | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 W MACARTHUR BLVD | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107521000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 W MACARTHUR BLVD | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107521000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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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 | 20A7816 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 00AX78160 | 05 | CA | MEDICAID |