Healthcare Provider Details

I. General information

NPI: 1770766479
Provider Name (Legal Business Name): ANDREW C. BREITERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27281 LAS RAMBLAS COAST RADIOLOGY IMAGING & INTERVENTION, INC, STE200
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

DEPT LA 21789
PASADENA CA
91185-1789
US

V. Phone/Fax

Practice location:
  • Phone: 949-212-6526
  • Fax: 949-420-3149
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG54442
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME94664
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM001433
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: