Provider Demographics
NPI:1770766479
Name:BREITERMAN, ANDREW C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:BREITERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT LA 21789
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1789
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-409-7005
Practice Address - Street 1:27281 LAS RAMBLAS
Practice Address - Street 2:COAST RADIOLOGY IMAGING & INTERVENTION, INC, STE200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-212-6526
Practice Address - Fax:949-420-3149
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG544422085R0202X
FLME946642085R0202X
GUM0014332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770766479Medicaid
CA00G544420OtherBLUE SHIELD
CACG954YMedicare UPIN
CA00G544420OtherBLUE SHIELD
CAH72210Medicare UPIN