Basic Information
| Provider Information | |||||||||
| NPI: | 1639312663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGLETON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | HAVENS RAMSEY | ||||||||
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| OtherLastName: | SINGLETON | ||||||||
| OtherFirstName: | ANDREW | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 31309 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900310309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234097761 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1044 S FAIR OAKS AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264494859 | ||||||||
| FaxNumber: | 6264030321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 06/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0102X | A135966 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 1134778806 | 05 | CA | MEDICAID |