Provider Demographics
NPI:1326152000
Name:LA VIA, ANNA CHARLOTTA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CHARLOTTA
Last Name:LA VIA
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 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 11180W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-829-5550
Mailing Address - Fax:310-829-5502
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 11180W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-829-5550
Practice Address - Fax:310-829-5502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72001Medicare UPIN