Provider Demographics
NPI:1992777098
Name:JANIK, ANDREW STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:STEPHEN
Last Name:JANIK
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 1:41750 RANCHO LAS PALMAS DR
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5511
Mailing Address - Country:US
Mailing Address - Phone:760-776-4770
Mailing Address - Fax:760-776-4772
Practice Address - Street 1:41750 RANCHO LAS PALMAS DR
Practice Address - Street 2:SUITE C-3
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5511
Practice Address - Country:US
Practice Address - Phone:760-776-4770
Practice Address - Fax:760-776-4772
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG259172084P0800X
HIMD-121832084P0800X
CO172822084P0800X
MO316982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ26498ZMedicare ID - Type Unspecified
A42831Medicare UPIN