Provider Demographics
NPI:1043479835
Name:GERMANOVICH, ANDREW (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GERMANOVICH
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W. LA VETA AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4246
Mailing Address - Country:US
Mailing Address - Phone:657-210-4096
Mailing Address - Fax:657-210-4233
Practice Address - Street 1:1120 W. LA VETA AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4246
Practice Address - Country:US
Practice Address - Phone:657-210-4096
Practice Address - Fax:657-210-4233
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12144207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114231OtherMEDICARE PTAN