Provider Demographics
NPI:1871056952
Name:RINCON, ANDRES
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:RINCON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 KY-321 #3
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-4600
Mailing Address - Country:US
Mailing Address - Phone:606-263-0507
Mailing Address - Fax:615-777-3309
Practice Address - Street 1:5311 KY ROUTE 321 STE 3
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9214
Practice Address - Country:US
Practice Address - Phone:606-263-0507
Practice Address - Fax:615-777-3309
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242066237700000X, 332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies