Provider Demographics
NPI:1417097452
Name:NEW ANANDA MEDICAL AND URGENT CARE, INC.
Entity Type:Organization
Organization Name:NEW ANANDA MEDICAL AND URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARATHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAYUVEGULA
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD, INC
Authorized Official - Phone:626-579-0103
Mailing Address - Street 1:1648 TYLER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3440
Mailing Address - Country:US
Mailing Address - Phone:626-579-0103
Mailing Address - Fax:626-579-0060
Practice Address - Street 1:1648 TYLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3440
Practice Address - Country:US
Practice Address - Phone:626-579-0103
Practice Address - Fax:626-579-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73424208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty