Provider Demographics
NPI:1376355016
Name:OVERLY-FITZGERALD, ANDI
Entity type:Individual
Prefix:
First Name:ANDI
Middle Name:
Last Name:OVERLY-FITZGERALD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:COSME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16870 W BERNARDO DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1678
Mailing Address - Country:US
Mailing Address - Phone:858-480-9405
Mailing Address - Fax:
Practice Address - Street 1:16870 W BERNARDO DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1678
Practice Address - Country:US
Practice Address - Phone:858-480-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula