Provider Demographics
NPI:1164486965
Name:CEAVATTA, ANDREW A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:CEAVATTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:264
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4053
Mailing Address - Country:US
Mailing Address - Phone:714-549-1770
Mailing Address - Fax:714-549-5049
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:264
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4053
Practice Address - Country:US
Practice Address - Phone:714-549-1770
Practice Address - Fax:714-549-5049
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-03-04
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Provider Licenses
StateLicense IDTaxonomies
CAG21227207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21227Medicare PIN