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General NPI Number Information
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NPI Number | 1164977005
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Entity Type | Individual
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Provider Name | ANDO MUNENO PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/21/2016
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 3501 JAMBOREE RD STE 1250
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2939
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Country | US
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Telephone | 310-971-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 220 NEWPORT CENTER DR # 11-282
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7506
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Country | US
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Telephone | 310-971-3243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-005499
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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