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General NPI Number Information
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NPI Number | 1326598962
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Entity Type | Organization
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Legal Business Name | ANDREW GERMANOVICH DO AN OSTEOPATHIC CORPORATION
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 1120 W LA VETA AVE STE 300
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City | ORANGE
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State | CA
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Zip | 92868-4246
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Provider Business Mailing Address
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Address Line | 5 HOLLAND STE 101
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City | IRVINE
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State | CA
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Zip | 92618-2568
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW GERMANOVICH
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Credential | DO
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Telephone | 949-588-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 20A12144
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 20A12144
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License Number State | CA
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