Provider Demographics
NPI:1245980648
Name:FATUROS, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FATUROS
Suffix:
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 1:4150 V ST # 1100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-2737
Mailing Address - Fax:
Practice Address - Street 1:MSC10 5550
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO, MSC08 4700
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4661
Practice Address - Fax:505-272-0475
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMRS2025-0191390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program