Provider Demographics
NPI:1639312663
Name:SINGLETON, ANDREW HAVENS RAMSEY
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HAVENS RAMSEY
Last Name:SINGLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:SINGLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-409-7761
Mailing Address - Fax:
Practice Address - Street 1:1044 S FAIR OAKS AVE STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2622
Practice Address - Country:US
Practice Address - Phone:626-449-4859
Practice Address - Fax:626-403-0321
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1359662086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134778806Medicaid