Healthcare Provider Details

I. General information

NPI: 1710031893
Provider Name (Legal Business Name): ANDREW MULLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE SUITE 101
PASADENA CA
91105-2561
US

IV. Provider business mailing address

301 S FAIR OAKS AVE SUITE 300
PASADENA CA
91105-2561
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-4500
  • Fax:
Mailing address:
  • Phone: 626-795-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG57401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: