Provider Demographics
NPI:1760042683
Name:ANIS, INAS (NP)
Entity Type:Individual
Prefix:
First Name:INAS
Middle Name:
Last Name:ANIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 MONTANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1808
Mailing Address - Country:US
Mailing Address - Phone:310-806-0959
Mailing Address - Fax:310-453-6990
Practice Address - Street 1:1610 MONTANA AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1808
Practice Address - Country:US
Practice Address - Phone:310-806-0959
Practice Address - Fax:310-453-6990
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN461744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner