Andre Conway, IDC Student
Student in an Organized Health Care Education/Training Program in San Diego, CA. Individual provider (NPI-1).
NPI number1356932016
StatusActive
Last updated in NPPESJan 26, 2021
Details
- NPI
- 1356932016
- Entity type
- Individual (NPI-1)
- Name
- Andre Conway
- Credential
- IDC Student
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 26, 2021
- Certification date
- Jan 26, 2021
- Last updated
- Jan 26, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
34101 Farenholt AveSan Diego, CA 92134-7000
Phone 619-532-9712
Mailing address
Building 14, 34101 Farenholt AveSan Diego, CA 92134
Phone 619-532-9712
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