Healthcare Provider Details

I. General information

NPI: 1780708933
Provider Name (Legal Business Name): ANDRE JOSEPH HUTCHISON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W 17TH ST
SANTA ANA CA
92706-3625
US

IV. Provider business mailing address

11355 ARROYO AVE
SANTA ANA CA
92705-2467
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-0709
  • Fax: 714-834-0705
Mailing address:
  • Phone: 714-543-0709
  • Fax: 714-834-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: