Provider Demographics
NPI:1992778757
Name:STARK, ANDREA ZATLIN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ZATLIN
Last Name:STARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ZATLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1182 RIVER ROCK LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4004
Mailing Address - Country:US
Mailing Address - Phone:480-272-1060
Mailing Address - Fax:
Practice Address - Street 1:1182 RIVER ROCK LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4004
Practice Address - Country:US
Practice Address - Phone:480-272-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34951208600000X
CAA120203207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery