Provider Demographics
NPI:1598964389
Name:MATHUR, ANJU (MD)
Entity Type:Individual
Prefix:MS
First Name:ANJU
Middle Name:
Last Name:MATHUR
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 1:1212 NORTH VERMONT AVENUE
Mailing Address - Street 2:#101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1704
Mailing Address - Country:US
Mailing Address - Phone:323-661-7661
Mailing Address - Fax:323-661-0747
Practice Address - Street 1:1212 N VERMONT AVE
Practice Address - Street 2:#101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1704
Practice Address - Country:US
Practice Address - Phone:323-661-7661
Practice Address - Fax:323-661-0747
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48468208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice