Healthcare Provider Details

I. General information

NPI: 1043479835
Provider Name (Legal Business Name): ANDREW GERMANOVICH D.O., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W. LA VETA AVENUE SUITE 300
ORANGE CA
92868-4246
US

IV. Provider business mailing address

1120 W. LA VETA AVENUE SUITE 300
ORANGE CA
92868-4246
US

V. Phone/Fax

Practice location:
  • Phone: 657-210-4096
  • Fax: 657-210-4233
Mailing address:
  • Phone: 657-210-4096
  • Fax: 657-210-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A12144
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A12144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: