Provider Demographics
NPI:1720684418
Name:FALAHEE, ANDREW (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FALAHEE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 S BROOKHURST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3563
Mailing Address - Country:US
Mailing Address - Phone:714-991-5700
Mailing Address - Fax:
Practice Address - Street 1:631 S BROOKHURST ST STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3563
Practice Address - Country:US
Practice Address - Phone:714-991-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant