Provider Demographics
NPI:1568411833
Name:PAPPAS, ANASTASIA (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:PAPPAS
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:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-1319
Mailing Address - Country:US
Mailing Address - Phone:209-543-6279
Mailing Address - Fax:209-543-6280
Practice Address - Street 1:12291 WASHINGTON BLVD
Practice Address - Street 2:500
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2500
Practice Address - Country:US
Practice Address - Phone:562-698-2541
Practice Address - Fax:562-698-0010
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF42604Medicare UPIN