Healthcare Provider Details

I. General information

NPI: 1508008178
Provider Name (Legal Business Name): ANDREW MAXWELL HANFLIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2009
Last Update Date: 11/29/2021
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 KATELLA AVE STE 150
LOS ALAMITOS CA
90720-3353
US

IV. Provider business mailing address

3851 KATELLA AVE STE 150
LOS ALAMITOS CA
90720-3353
US

V. Phone/Fax

Practice location:
  • Phone: 562-314-1400
  • Fax: 562-431-0564
Mailing address:
  • Phone: 562-314-1400
  • Fax: 562-431-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA136847
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA136847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: