MEDICARE: DR. ROBERT WALTER ANDONIAN M.D.

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
1	208800000X	Urology Physician	C36500	CA

General Provider Information

NPI Number	:	1215964242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WALTER ANDONIAN M.D.

Provider Business Mailing Address
First Line	:	123 DI SALVO AVE
Second Line	:	SUITE D
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1717
Country	:	US
Telephone Number	:	408-279-0742
Fax Number	:	408-279-1019

Provider Business Practice Location Address
First Line	:	123 DI SALVO AVE
Second Line	:	SUITE D
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1717
Country	:	US
Telephone Number	:	408-279-0742
Fax Number	:	408-279-1019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/01/2010

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