Provider Demographics
NPI:1386742799
Name:ZIVITZ, ANDREW MARK (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:ZIVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5210 FLORE TERR
Mailing Address - Street 2:L-210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-581-1311
Mailing Address - Fax:858-581-1311
Practice Address - Street 1:5210 FLORE TERR
Practice Address - Street 2:L-210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122
Practice Address - Country:US
Practice Address - Phone:858-581-1311
Practice Address - Fax:858-581-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC37110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC37110OtherMEDICAL LICENSE