Provider Demographics
NPI:1376744326
Name:ANZA MEDICAL CENTER
Entity Type:Organization
Organization Name:ANZA MEDICAL CENTER
Other - Org Name:ANZA VALLEY COMPASSION INCORPORATED
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-MANAGER,PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:NAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,FNP
Authorized Official - Phone:951-763-2700
Mailing Address - Street 1:PO BOX 390799
Mailing Address - Street 2:
Mailing Address - City:ANZA
Mailing Address - State:CA
Mailing Address - Zip Code:92539-0799
Mailing Address - Country:US
Mailing Address - Phone:951-763-2700
Mailing Address - Fax:
Practice Address - Street 1:56030 HIGHWAY 371
Practice Address - Street 2:
Practice Address - City:ANZA
Practice Address - State:CA
Practice Address - Zip Code:92539-0799
Practice Address - Country:US
Practice Address - Phone:925-763-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health