Provider Demographics
NPI:1720015258
Name:ANVARI, VASILIKI M (MD)
Entity Type:Individual
Prefix:DR
First Name:VASILIKI
Middle Name:M
Last Name:ANVARI
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 1:1607 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2927
Mailing Address - Country:US
Mailing Address - Phone:619-495-6831
Mailing Address - Fax:
Practice Address - Street 1:250 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1943
Practice Address - Country:US
Practice Address - Phone:619-522-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88444207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110909Medicaid
AZ112974Medicare PIN
CABO696ZMedicare PIN
AZG78250Medicare UPIN