Provider Demographics
NPI:1538120860
Name:ANAYA, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:ANAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2429
Mailing Address - Country:US
Mailing Address - Phone:361-653-6361
Mailing Address - Fax:361-653-6371
Practice Address - Street 1:5913 PATTON ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2429
Practice Address - Country:US
Practice Address - Phone:361-653-6361
Practice Address - Fax:361-653-6371
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE15092080N0001X
TXN34462080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13294001Medicaid
AR13294001Medicaid