1871627463 NPI number — EMIL A ANAYA MD, INC. A MEDICAL CORPORATION

Table of content: (NPI 1871627463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871627463 NPI number — EMIL A ANAYA MD, INC. A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMIL A ANAYA MD, INC. A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871627463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95156-3133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-258-8760
Provider Business Mailing Address Fax Number:
408-258-3645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 N BASCOM AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-258-8760
Provider Business Practice Location Address Fax Number:
408-258-8760
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANAYA
Authorized Official First Name:
EMIL
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
408-258-8760

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  A25810 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1811994445 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ06033Z . This is a "GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A25810 . This is a "CALIFORNIA MEDICAL LICENS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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