Healthcare Provider Details

I. General information

NPI: 1144547977
Provider Name (Legal Business Name): ANDREI RADULESCU M.D.,PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CAMPUS ST STE 21111
LOMA LINDA CA
92350
US

IV. Provider business mailing address

11175 CAMPUS ST STE 21111
LOMA LINDA CA
92350-3471
US

V. Phone/Fax

Practice location:
  • Phone: 614-432-3145
  • Fax:
Mailing address:
  • Phone: 614-432-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number157673
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number157673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: