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General NPI Number Information
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NPI Number | 1235573239
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Entity Type | Individual
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Provider Name | ANDREW CONSTANTINE MARIO DJUNAIDI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2013
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 5901 E 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90822-5201
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Country | US
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Telephone | 562-826-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 CHAD CT
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City | MURFREESBORO
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State | TN
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Zip | 37129-0830
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Country | US
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Telephone | 615-427-2008
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A135054
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License Number State | CA
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