Provider Demographics
NPI:1497139182
Name:VASA, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:VASA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:BAROT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4127 MCLAUGHLIN AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5479
Mailing Address - Country:US
Mailing Address - Phone:510-517-1647
Mailing Address - Fax:
Practice Address - Street 1:LEVEL 30, BHIRAJ TOWER AT EMQUARTIER, 689 SUKHUMWIT RD.
Practice Address - Street 2:
Practice Address - City:NORTH KLONGTON
Practice Address - State:VADHANA, BANGKOK
Practice Address - Zip Code:10110
Practice Address - Country:TH
Practice Address - Phone:0982-715-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA473757121Medicaid