Individual
ANDREW LAZARO FONTICIELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA STUDENT
Contact information
Practice address
16037 VIA DEL SOL, SAN LORENZO, CA 94580-2407
(818) 935-7076
Mailing address
16037 VIA DEL SOL, SAN LORENZO, CA 94580-2407
(818) 935-7076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA67745
CA
363A00000X
Physician Assistant
STUDENT
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CA
Other
Enumeration date
02/20/2025
Last updated
04/10/2026
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