MEDICARE: DR. ANDREW FOND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	A103284	CA

General Provider Information

NPI Number	:	1588859235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW FOND M.D.

Provider Business Mailing Address
First Line	:	1520 SAN PABLO ST STE 3450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5325
Country	:	US
Telephone Number	:	323-442-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 SAN PABLO ST STE 3450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5325
Country	:	US
Telephone Number	:	323-442-6202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	11/29/2021

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