Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC26838 | CA |
NPI | 1972645950 |
---|---|
Provider Name | John P Andrus |
First Address | La Jolla, CA 92037-1714 |
Second Address | La Jolla, CA 92037-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |