Healthcare Provider Details

I. General information

NPI: 1215060512
Provider Name (Legal Business Name): ANDREW R. JARMINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SUPERIOR AVE STE 304
NEWPORT BEACH CA
92663-3641
US

IV. Provider business mailing address

1501 SUPERIOR AVE STE 304
NEWPORT BEACH CA
92663-3641
US

V. Phone/Fax

Practice location:
  • Phone: 949-423-7003
  • Fax:
Mailing address:
  • Phone: 949-423-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA051383
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA051383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: