Provider Demographics
NPI:1255117594
Name:HORTIZUELA, KAHREENA ANDAYA (FNP)
Entity type:Individual
Prefix:
First Name:KAHREENA
Middle Name:ANDAYA
Last Name:HORTIZUELA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6906
Mailing Address - Country:US
Mailing Address - Phone:209-507-2401
Mailing Address - Fax:
Practice Address - Street 1:780 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4565
Practice Address - Country:US
Practice Address - Phone:562-624-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95025463363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner