1700455599 NPI number — ANDREW PARKER JOZWIAKOWSKI MD

Table of content: ANDREW PARKER JOZWIAKOWSKI MD (NPI 1700455599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700455599 NPI number — ANDREW PARKER JOZWIAKOWSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOZWIAKOWSKI
Provider First Name:
ANDREW
Provider Middle Name:
PARKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700455599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 GRACELINE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50701-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-488-3758
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 SOQUEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOQUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95073-2427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-888-9410
Provider Business Practice Location Address Fax Number:
831-477-7795
Provider Enumeration Date:
06/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  FJ4386339 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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