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General NPI Number Information
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NPI Number | 1952598203
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Entity Type | Organization
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Legal Business Name | ANDREW A CEAVATTA MD INC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 11100 WARNER AVE 264
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-549-1770
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Fax | 714-549-5049
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Provider Business Mailing Address
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Address Line | 11100 WARNER AVE 264
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-549-1770
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Fax | 714-549-5049
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW ANTHONY CEAVATTA
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Credential | MD
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Telephone | 714-549-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G21227
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License Number State | CA
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