Provider Demographics
NPI:1447816491
Name:KAMINSKY, ANDREW (NP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KAMINSKY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W BROADWAY STE 700
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3370
Mailing Address - Country:US
Mailing Address - Phone:877-936-2873
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY STE 700
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3370
Practice Address - Country:US
Practice Address - Phone:877-936-2873
Practice Address - Fax:877-882-6925
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY742150163WP0808X
CA95022117363LP0808X
NY402659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health