Provider Demographics
NPI:1497167787
Name:TAPADIA, ANJALI D (MD)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:D
Last Name:TAPADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 YORBA PL STE 205
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3107
Mailing Address - Country:US
Mailing Address - Phone:714-912-7002
Mailing Address - Fax:
Practice Address - Street 1:1075 YORBA PL STE 205
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3107
Practice Address - Country:US
Practice Address - Phone:714-912-7002
Practice Address - Fax:714-975-9822
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35137351207W00000X
CAA155328207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0367279Medicaid