Provider Demographics
NPI:1700887833
Name:IRANIHA, ANDREW S (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:IRANIHA
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:496 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4264
Mailing Address - Country:US
Mailing Address - Phone:949-646-8444
Mailing Address - Fax:949-646-8388
Practice Address - Street 1:496 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4264
Practice Address - Country:US
Practice Address - Phone:949-646-8444
Practice Address - Fax:949-646-8388
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55391OtherSTATE MEDICAL LICENSE
CAA55391Medicare PIN
CAA55391OtherSTATE MEDICAL LICENSE