Healthcare Provider Details

I. General information

NPI: 1447816491
Provider Name (Legal Business Name): ANDREW KAMINSKY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W BROADWAY STE 700
SAN DIEGO CA
92101-3370
US

IV. Provider business mailing address

600 W BROADWAY STE 700
SAN DIEGO CA
92101-3370
US

V. Phone/Fax

Practice location:
  • Phone: 877-936-2873
  • Fax: 877-882-6925
Mailing address:
  • Phone: 877-936-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number742150
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95022117
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: