Provider Demographics
NPI:1790281301
Name:NATH, ANUSHA (MD)
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:NATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S IDAHO ST STE 190
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6047
Mailing Address - Country:US
Mailing Address - Phone:562-690-0400
Mailing Address - Fax:562-690-3182
Practice Address - Street 1:501 S IDAHO ST STE 190
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6047
Practice Address - Country:US
Practice Address - Phone:562-690-0400
Practice Address - Fax:562-690-3182
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA175000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics