Provider Demographics
NPI:1447687447
Name:GOCHE, ANDREA
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:GOCHE
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 1:12065 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0346
Mailing Address - Country:US
Mailing Address - Phone:915-245-7093
Mailing Address - Fax:
Practice Address - Street 1:6358 EDGEMERE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3517
Practice Address - Country:US
Practice Address - Phone:915-562-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
TX1314972225100000X
TX146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant