Provider Demographics
NPI:1346095114
Name:ANAYA, ITZEL (PHD)
Entity Type:Individual
Prefix:
First Name:ITZEL
Middle Name:
Last Name:ANAYA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 IVY DR APT 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2173
Mailing Address - Country:US
Mailing Address - Phone:909-518-2772
Mailing Address - Fax:
Practice Address - Street 1:3779 PIEDMONT AVE FL G-41
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5347
Practice Address - Country:US
Practice Address - Phone:510-752-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical