Provider Demographics
NPI:1093817918
Name:ANENIH, JAMES OBEHI (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:OBEHI
Last Name:ANENIH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N PACIFIC AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4313
Mailing Address - Country:US
Mailing Address - Phone:818-552-5000
Mailing Address - Fax:818-552-2959
Practice Address - Street 1:1101 N PACIFIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4313
Practice Address - Country:US
Practice Address - Phone:818-552-5000
Practice Address - Fax:818-552-2959
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17433207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17433OtherPHYSICIAN ASSISTANT