Provider Demographics
NPI:1205203510
Name:SUSHIL ANAND M.D., FAAP
Entity Type:Organization
Organization Name:SUSHIL ANAND M.D., FAAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-338-6596
Mailing Address - Street 1:304 W F ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3206
Mailing Address - Country:US
Mailing Address - Phone:909-983-4746
Mailing Address - Fax:909-983-9766
Practice Address - Street 1:304 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3206
Practice Address - Country:US
Practice Address - Phone:909-983-4746
Practice Address - Fax:909-983-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110593261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA110593OtherCALIFORNIA MEDICAL BOARD
FP1785293OtherFEDERAL DEA