Provider Demographics
NPI:1780708933
Name:HUTCHISON, ANDRE JOSEPH (PA)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:JOSEPH
Last Name:HUTCHISON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:11355 ARROYO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2467
Mailing Address - Country:US
Mailing Address - Phone:714-543-0709
Mailing Address - Fax:714-834-0705
Practice Address - Street 1:812 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3625
Practice Address - Country:US
Practice Address - Phone:714-543-0709
Practice Address - Fax:714-834-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10379363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR00817000Medicare ID - Type Unspecified