Provider Demographics
NPI:1336849801
Name:ANDREICA, ELEONORA
Entity type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:ANDREICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17830 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1120
Mailing Address - Country:US
Mailing Address - Phone:503-939-0308
Mailing Address - Fax:
Practice Address - Street 1:2715 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6641
Practice Address - Country:US
Practice Address - Phone:480-256-0104
Practice Address - Fax:503-974-2269
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health