Provider Demographics
NPI:1285850800
Name:JETHVA, ANAND
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:JETHVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2706
Mailing Address - Country:US
Mailing Address - Phone:714-767-2851
Mailing Address - Fax:
Practice Address - Street 1:11818 ROSECRANS AVE # A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4101
Practice Address - Country:US
Practice Address - Phone:562-462-1715
Practice Address - Fax:562-462-1731
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 50334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist