Healthcare Provider Details

I. General information

NPI: 1992777098
Provider Name (Legal Business Name): ANDREW STEPHEN JANIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41750 RANCHO LAS PALMAS DR SUITE C-3
RANCHO MIRAGE CA
92270-5511
US

IV. Provider business mailing address

41750 RANCHO LAS PALMAS DR SUITE C-3
RANCHO MIRAGE CA
92270-5511
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-4770
  • Fax: 760-776-4772
Mailing address:
  • Phone: 760-776-4770
  • Fax: 760-776-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG25917
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-12183
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17282
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31698
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: