Basic Information
Provider Information
NPI: 1639567332
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAURIN
FirstName: ANDREW
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4469 SUNBURST DR
Address2:  
City: OCEANSIDE
State: CA
PostalCode: 920563541
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5717 PACIFIC CENTER BLVD STE 200
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921214250
CountryCode: US
TelephoneNumber: 8588591188
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/03/2015
LastUpdateDate: 05/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X52099CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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