Provider Demographics
NPI:1538921135
Name:KONITZER, ANDREW WILLIAM JR
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:KONITZER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4827
Mailing Address - Country:US
Mailing Address - Phone:530-354-3171
Mailing Address - Fax:
Practice Address - Street 1:3211 COHASSET RD STE 130
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5403
Practice Address - Country:US
Practice Address - Phone:530-552-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist