Provider Demographics
NPI:1073645263
Name:IMBUS, ANDREW HAUGHEY (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:HAUGHEY
Last Name:IMBUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:665 W NAOMI AVE
Mailing Address - Street 2:#202
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7563
Mailing Address - Country:US
Mailing Address - Phone:626-445-6275
Mailing Address - Fax:626-445-3583
Practice Address - Street 1:665 W NAOMI AVE
Practice Address - Street 2:#202
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7563
Practice Address - Country:US
Practice Address - Phone:626-445-6275
Practice Address - Fax:626-445-3583
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical