Healthcare Provider Details

I. General information

NPI: 1073611778
Provider Name (Legal Business Name): ANDREA A KOVACS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA KOVACS LOOMIS

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVENUE, MEDICAL VILLAGE OPD 5 WEST
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1000 S. FREEMONT AVENUE, UNIT 62, SUITE 10220
ALHAMBRA CA
91803
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-2200
  • Fax: 323-226-3971
Mailing address:
  • Phone: 626-457-5820
  • Fax: 626-457-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberG41428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: