Provider Demographics
NPI:1578081022
Name:JENSEN, ANDREW WILLAIM
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WILLAIM
Last Name:JENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 CLAIREMONT DR APT 38
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6768
Mailing Address - Country:US
Mailing Address - Phone:619-261-7403
Mailing Address - Fax:
Practice Address - Street 1:1400 CAMINO DE LA REINA STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1512
Practice Address - Country:US
Practice Address - Phone:619-299-6060
Practice Address - Fax:619-299-5379
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies