Provider Demographics
NPI:1457434284
Name:ONAGHISE, ANDREW O
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:O
Last Name:ONAGHISE
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 1:204 N MANHATTAN PL APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4030
Mailing Address - Country:US
Mailing Address - Phone:213-639-4704
Mailing Address - Fax:
Practice Address - Street 1:3075 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1205
Practice Address - Country:US
Practice Address - Phone:213-639-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator