Provider Demographics
NPI:1487941282
Name:FODOREANU, ANDREI C (MD)
Entity type:Individual
Prefix:
First Name:ANDREI
Middle Name:C
Last Name:FODOREANU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 GIRARD AVE STE 1405
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5149
Mailing Address - Country:US
Mailing Address - Phone:619-290-1344
Mailing Address - Fax:
Practice Address - Street 1:7514 GIRARD AVE STE 1405
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5149
Practice Address - Country:US
Practice Address - Phone:619-290-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA122579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program