Provider Demographics
NPI:1346370582
Name:SASSANI, ANDREW A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:SASSANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75034
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-0168
Mailing Address - Country:US
Mailing Address - Phone:949-493-5074
Mailing Address - Fax:949-493-4741
Practice Address - Street 1:31872 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6773
Practice Address - Country:US
Practice Address - Phone:949-493-5074
Practice Address - Fax:949-493-4741
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA867472084A0401X, 2084P0800X, 2084P0802X, 2084P0804X, 2084P0805X, 2084P2900X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18481OtherMEDICARE GROUP ID
W18481OtherMEDICARE GROUP ID
WA86747AMedicare ID - Type Unspecified