Healthcare Provider Details

I. General information

NPI: 1972252054
Provider Name (Legal Business Name): ANDREW ROBIN LEGENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SCHRADER BLVD
LOS ANGELES CA
90028-6213
US

IV. Provider business mailing address

7120 LEXINGTON AVE APT 5
WEST HOLLYWOOD CA
90046-5837
US

V. Phone/Fax

Practice location:
  • Phone: 323-993-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95240755
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95240755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: