Andrew Lazaro Fonticiella, PA STUDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

16037 Via del Sol
San Lorenzo, CA 94580-2407

Phone

(818) 935-7076

NPI assigned

Feb 20, 2025

Last updated

Apr 10, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Team Physicians of California Medical Group IncGroup PAC ID 8224945084, 92 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Lodi Memorial Hospital, Lodi, CA, CCN 050336

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Team Physicians of California Medical Group Inc

  • Emergency Medicine Physician
  • Delano, CA
  • NPI 1447288345
  Medicare reassignment Care Compare group
• Clinic Services of California Medical Group Inc

  • Emergency Medicine Physician
  • Lodi, CA
  • NPI 1578958450
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lodi Memorial Hospital Association Inc

  dba Lodi Memorial Hospital

  • General Acute Care Hospital
  • Lodi, CA
  • NPI 1316938301
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775779200000",
    "number": "1023814001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16037 VIA DEL SOL",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945802407",
            "telephone_number": "818-935-7076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16037 VIA DEL SOL",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945802407",
            "telephone_number": "818-935-7076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTICIELLA",
        "first_name": "ANDREW",
        "middle_name": "LAZARO",
        "credential": "PA STUDENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-20",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA67745",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annalyn Damani, PT
• Araceli Oreto De Vera, RN
• Frances Delgadillo, LCSW
• East Bay Agency for Children
• Maureen U Ezeigwe
• G Kohli Professional Dental Corporation
• Nicole D Gallegos
• Irene Villacorta Garcia
• Brandi S Gates
• Stephanie Camille Gella, MS OTR/L

• Student in an Organized Health Care Education/Training Program in San Lorenzo, CA
• Providers in San Lorenzo, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.