Healthcare Provider Details

I. General information

NPI: 1386657039
Provider Name (Legal Business Name): ANDREW CASSIDENTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 560
ORANGE CA
92868-4214
US

IV. Provider business mailing address

43 LAGUNA WOODS DR
LAGUNA NIGUEL CA
92677-2829
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-0101
  • Fax: 714-835-1133
Mailing address:
  • Phone: 949-683-7899
  • Fax: 661-326-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG55330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: