Provider Demographics
NPI:1437785268
Name:ANDRZEJEWSKI, DEREK F (PA-C)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:F
Last Name:ANDRZEJEWSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N PONDEROSA DR STE B111
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2379
Mailing Address - Country:US
Mailing Address - Phone:805-482-8989
Mailing Address - Fax:805-987-2855
Practice Address - Street 1:2412 N PONDEROSA DR STE B111
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2379
Practice Address - Country:US
Practice Address - Phone:805-482-8989
Practice Address - Fax:805-987-2855
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57779363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57779OtherSTATE LICENSE
CA57779OtherSTATE LICENSE