Healthcare Provider Details

I. General information

NPI: 1649740473
Provider Name (Legal Business Name): ANDREW JAMES AZEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 VERMONT AVE
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

16 SOBRANTE
ALISO VIEJO CA
92656-7077
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-6948
  • Fax:
Mailing address:
  • Phone: 714-478-7621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number36071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: