Provider Demographics
NPI:1467957654
Name:E PETER ANZALDO MD INC
Entity Type:Organization
Organization Name:E PETER ANZALDO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-997-7140
Mailing Address - Street 1:1310 W STEWART DR STE 403
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3855
Mailing Address - Country:US
Mailing Address - Phone:714-997-7140
Mailing Address - Fax:714-639-0920
Practice Address - Street 1:1310 W STEWART DR STE 403
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3855
Practice Address - Country:US
Practice Address - Phone:714-997-7140
Practice Address - Fax:714-639-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36638207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G366380Medicaid