Provider Demographics
NPI:1982088357
Name:SHOVER, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SHOVER
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 1:3746 FOOTHILL BLVD # B140
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1740
Mailing Address - Country:US
Mailing Address - Phone:310-445-5999
Mailing Address - Fax:
Practice Address - Street 1:1000 W. CARSON ST. BOX 461
Practice Address - Street 2:HARBOR-UCLA MEDICAL CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509
Practice Address - Country:US
Practice Address - Phone:310-222-2700
Practice Address - Fax:310-533-1841
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97840208600000X
CAA147623208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery