Provider Demographics
NPI:1164678181
Name:RANGWALA, ANISA MANSOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANISA
Middle Name:MANSOOR
Last Name:RANGWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1406
Mailing Address - Country:US
Mailing Address - Phone:408-937-2218
Mailing Address - Fax:
Practice Address - Street 1:1993 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133
Practice Address - Country:US
Practice Address - Phone:408-937-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine