Healthcare Provider Details

I. General information

NPI: 1740608942
Provider Name (Legal Business Name): JOHN ANDRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 FELA AVE
LONG BEACH CA
90808-3209
US

IV. Provider business mailing address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 708-732-9429
  • Fax:
Mailing address:
  • Phone: 916-734-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA169149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: