ANDREA CARRUTH (NPI# 1093050718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093050718 |
| Entity Type | Individual |
| Full Name | ANDREA CARRUTH |
| Practice Address |
1947 N California St Ste B Stockton CA 95204-6029 |
| Mailing Address |
1947 N California St Ste B Stockton CA 95204 |
| Practice Telephone | 2094630870 |
| Practice Fax Number | 2094631803 |
| Mailing Telephone | 2094630870 |
| Mailing Fax Number | 2094631803 |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2017-06-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548788003 | Andrea Mari Carruth | Occupational Therapist | 4502 Medical Dr, San Antonio, TX 78229-4402 | 2017-09-05 |
| Street Address |
1947 N CALIFORNIA ST STE B |
| City | STOCKTON |
| State | CA |
| Zip Code | 95204-6029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295063139 | Lia Davis | Licensed Vocational Nurse | 1947 N California St Ste B, Stockton, CA 95204-6029 | 2009-12-04 |
| 1114320652 | Bernadette Pua | Licensed Vocational Nurse | 1947 N California St Ste B, Stockton, CA 95204-6029 | 2014-09-29 |
| 1578976569 | Paul Pelletier | Counselor | 1947 N California St Ste B, Stockton, CA 95204-6029 | 2014-06-06 |
| 1174824650 | Anna Marie Regalado | Counselor | 1947 N California St Ste B, Stockton, CA 95204-6029 | 2010-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962027524 | Kariem Abdelwahed | Licensed Vocational Nurse | 1630 N. Edison St Stockton Ca, Stockton, CA 95204 | 2020-06-10 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1235614116 | Michelle Ann Horn | Marriage & Family Therapist | 3666 Mission Rd, Stockton, CA 95204 | 2018-09-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1790228781 | Rebecca Phongsa | Counselor | 1947 North Calfornia Street, Suite B, Stockton, CA 95204 | 2016-11-23 |
| 1700332905 | Serim Kang | Driver | 4222 N Pershing Ave, Suite D2, Stockton, CA 95204 | 2016-08-28 |
| 1033565544 | Philip John Brereton | Orthotist | 466 E Harding Way, Stockton, CA 95204 | 2016-05-13 |
| 1932507522 | David Grayson | Counselor | 1621 Brookside Rd, Stockton, CA 95204 | 2014-12-12 |
| 1174934897 | Gurtej Malhi | Internal Medicine | 1901 N California Street, Stockton, CA 95204 | 2014-05-15 |
| 1396156170 | Rajesh Saini | Nurse Practitioner | 1805 N California St. Suite 102, Stockton, CA 95204 | 2014-05-14 |
| Find all providers in zip 95204 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740893155 | Tracey Black | Counselor | 130 W Flora St, Stockton, CA 95202-1636 | 2020-08-25 |
| 1699305508 | Juan Robles | Counselor | 1947 N California St # 95204, Stockton, CA 95204-6029 | 2020-01-20 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1821648353 | Kaye Lynn Scott-roy | Counselor | 285 H Rd, Stockton, KS 67669-8889 | 2019-09-17 |
| 1760049043 | Jay Frank Williams | Counselor | 1105 N El Dorado St, Stockton, CA 95202-1305 | 2019-05-22 |
| 1184105462 | Rachelle Diane Wilson | Counselor | 2733 N Sutter St, Stockton, CA 95204-4548 | 2018-08-24 |
| 1568943835 | Heather Lynn Rogers | Counselor | 3990 Black Butte Cir, Stockton, CA 95209-3500 | 2018-08-24 |
| 1235631722 | Parker Yang | Counselor | 1111 N. El Dorado St, Stockton, CA 95202 | 2018-03-01 |
| 1487162087 | Linda Soun | Counselor | 1111 N. El Dorado Street, Stockton, CA 95202 | 2018-01-17 |
| 1760995781 | Dana Lamont Harris | Counselor | 2833 Buckner Ct, Stockton, CA 95207-2302 | 2017-11-13 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.