Provider Demographics
NPI:1659678795
Name:ANFITEATRO, ADRIANN L (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANN
Middle Name:L
Last Name:ANFITEATRO
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:MS
Other - First Name:ADRIANN
Other - Middle Name:L
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-0514
Mailing Address - Country:US
Mailing Address - Phone:626-344-7874
Mailing Address - Fax:888-789-5484
Practice Address - Street 1:2529 S SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5174
Practice Address - Country:US
Practice Address - Phone:626-344-7874
Practice Address - Fax:888-789-5484
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 295176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife