Healthcare Provider Details

I. General information

NPI: 1730460577
Provider Name (Legal Business Name): MR. ANDREW P ISKANDAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6617
US

IV. Provider business mailing address

420 S SAN PEDRO ST STE G4
LOS ANGELES CA
90013-1938
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax: 626-577-2543
Mailing address:
  • Phone: 213-620-5712
  • Fax: 213-621-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW36335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: