Basic Information
| Provider Information | |||||||||
| NPI: | 1366442998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONCOFF | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2141 N HARBOR BLVD STE 35000 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146268630 | ||||||||
| FaxNumber: | 7146268659 | ||||||||
| Practice Location | |||||||||
| Address1: | 2141 N HARBOR BLVD STE 35000 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146268630 | ||||||||
| FaxNumber: | 7146268659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | A55793 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RS0010X | A55793 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.