Provider Demographics
NPI:1861829277
Name:ANDREW WASSEF MD
Entity Type:Organization
Organization Name:ANDREW WASSEF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-310-6237
Mailing Address - Street 1:2200 W THIRD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1901
Mailing Address - Country:US
Mailing Address - Phone:213-484-7600
Mailing Address - Fax:818-638-5762
Practice Address - Street 1:17525 VENTURA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5109
Practice Address - Country:US
Practice Address - Phone:818-986-0200
Practice Address - Fax:818-638-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120817207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982848099OtherINS NPI