Provider Demographics
NPI:1407199912
Name:EKSTROM, ANNA VICTORIA (DO, MPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VICTORIA
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 MOWRY AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1638
Mailing Address - Country:US
Mailing Address - Phone:510-362-7503
Mailing Address - Fax:
Practice Address - Street 1:2299 MOWRY AVE STE 2A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1638
Practice Address - Country:US
Practice Address - Phone:510-362-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics