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NPI Code Detail

MEDICARE: ANDREW W HESSELTINE, M.D., INC

MEDICARE: ANDREW W HESSELTINE, M.D., INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant18753CA
2207LP2900XPain Medicine (Anesthesiology) PhysicianA66517CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1FNP 34858OTHERCAFICTITIOUS NAME PERMIT

General Provider Information

NPI Number : 1184766685
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDREW W HESSELTINE, M.D., INC
Provider Business Mailing Address
First Line : 1850 E WASHINGTON ST
Second Line :
City : COLTON
State : CA
Zip : 92324-4621
Country : US
Telephone Number : 909-887-2991
Fax Number : 909-887-5694
Provider Business Practice Location Address
First Line : 1850 E WASHINGTON ST
Second Line :
City : COLTON
State : CA
Zip : 92324-4621
Country : US
Telephone Number : 909-887-2991
Fax Number : 909-887-5694
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : ANDREW W HESSELTINE
Credential : M.D.
Telephone Number : 909-887-2991
Provider Enumeration Date : 02/12/2007
Last Update Date : 02/01/2023

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1902060361 — MS. ALEXANDRIA I ARIAS PA-C
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