Provider Demographics
NPI:1295864536
Name:PRINCE, ANETA LOTAKOV (MD)
Entity Type:Individual
Prefix:DR
First Name:ANETA
Middle Name:LOTAKOV
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANETA
Other - Middle Name:MARIANNA
Other - Last Name:LOTAKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 573304
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-3304
Mailing Address - Country:US
Mailing Address - Phone:818-887-4487
Mailing Address - Fax:
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA903702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry