Healthcare Provider Details

I. General information

NPI: 1841721867
Provider Name (Legal Business Name): ANDREW JEFFREY DAVIDOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 SHERMAN WAY
VAN NUYS CA
91406-3782
US

IV. Provider business mailing address

16650 SHERMAN WAY
VAN NUYS CA
91406-3782
US

V. Phone/Fax

Practice location:
  • Phone: 818-785-0103
  • Fax:
Mailing address:
  • Phone: 818-785-0103
  • Fax:

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA162264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: