Provider Demographics
NPI:1346296944
Name:CARSTENSEN, ANITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:M
Last Name:CARSTENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-451-1196
Mailing Address - Fax:510-451-0410
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-451-1196
Practice Address - Fax:510-451-0410
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A448730Medicaid
CAGR0045150Medicaid
CAF17801Medicare UPIN
CA00A448730Medicaid