Provider Demographics
NPI:1760932230
Name:ANTHER MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANTHER MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:ARCILLA
Authorized Official - Last Name:TABLIZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-382-5753
Mailing Address - Street 1:1290 EAST SPRUCE AVE,SUITE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3371
Mailing Address - Country:US
Mailing Address - Phone:559-840-0437
Mailing Address - Fax:559-840-0037
Practice Address - Street 1:1290 E SPRUCE AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3371
Practice Address - Country:US
Practice Address - Phone:323-382-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty