Provider Demographics
NPI:1750301271
Name:JAAGMD
Entity Type:Organization
Organization Name:JAAGMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAGNOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-378-4434
Mailing Address - Street 1:94 AMATO AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1805
Mailing Address - Country:US
Mailing Address - Phone:408-378-4434
Mailing Address - Fax:408-245-1305
Practice Address - Street 1:1309 S MARY AVE
Practice Address - Street 2:SUITE NUMBER 135
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3050
Practice Address - Country:US
Practice Address - Phone:408-245-1300
Practice Address - Fax:408-245-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8302702084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G830270OtherBLUE SHIELD
CA00G830271OtherBLUE SHIELD
CA00G830272Medicare ID - Type Unspecified
CA00G830270OtherBLUE SHIELD
CA00G830271Medicare ID - Type Unspecified