Healthcare Provider Details

I. General information

NPI: 1184766685
Provider Name (Legal Business Name): ANDREW W HESSELTINE, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E WASHINGTON ST
COLTON CA
92324-4621
US

IV. Provider business mailing address

1850 E WASHINGTON ST
COLTON CA
92324-4621
US

V. Phone/Fax

Practice location:
  • Phone: 909-887-2991
  • Fax: 909-887-5694
Mailing address:
  • Phone: 909-887-2991
  • Fax: 909-887-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA66517
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18753
License Number StateCA

VIII. Authorized Official

Name: ANDREW W HESSELTINE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 909-887-2991