Healthcare Provider Details

I. General information

NPI: 1043402373
Provider Name (Legal Business Name): ANDREW D RENDOFF P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/08/2022
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 N VISTOSO PARK RD
ORO VALLEY AZ
85755-5819
US

IV. Provider business mailing address

PO BOX 31630
TUCSON AZ
85751-1630
US

V. Phone/Fax

Practice location:
  • Phone: 520-544-9700
  • Fax: 520-618-6060
Mailing address:
  • Phone: 520-784-6200
  • Fax: 520-784-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberT01462
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9077
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2017012741
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9077
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: