Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G071080 | CA |
Y | 111NI0900X | Internist | G071080 | CA |
NPI | 1003164302 |
---|---|
Provider Name | Dr. John Sturdivant Andrews |
First Address | San Diego, CA 92101-7638 |
Second Address | La Jolla, CA 92037-6253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2012 |
Last Update Date | 17/08/2012 |