Provider Demographics
NPI:1093749533
Name:SO, ANDREW J (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SO
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3000 W MACARTHUR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6982
Mailing Address - Country:US
Mailing Address - Phone:949-216-3244
Mailing Address - Fax:
Practice Address - Street 1:3000 W MACARTHUR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6982
Practice Address - Country:US
Practice Address - Phone:949-216-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17558207P00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine