Healthcare Provider Details

I. General information

NPI: 1982101762
Provider Name (Legal Business Name): ANDREW JEFFERY MOCK MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 JAMBOREE RD
NEWPORT BEACH CA
92660-2526
US

IV. Provider business mailing address

5190 CAMPUS DR
NEWPORT BEACH CA
92660-2101
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0951
  • Fax: 949-557-0952
Mailing address:
  • Phone: 949-557-0951
  • Fax: 949-557-0952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA163587
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA163587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: