Healthcare Provider Details

I. General information

NPI: 1619945581
Provider Name (Legal Business Name): ANDREW IRA SPITZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD SUITE 603
LOS ANGELES CA
90048-4165
US

IV. Provider business mailing address

PO BOX 512717
LOS ANGELES CA
90051-0717
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9211
  • Fax: 310-665-7256
Mailing address:
  • Phone: 310-423-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG74228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: