Provider Demographics
NPI:1851475271
Name:ANAYAS, CONCEPCION SORILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CONCEPCION
Middle Name:SORILLA
Last Name:ANAYAS
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 1:1190 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2511
Mailing Address - Country:US
Mailing Address - Phone:386-738-1792
Mailing Address - Fax:386-738-4865
Practice Address - Street 1:1190 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2511
Practice Address - Country:US
Practice Address - Phone:386-738-1792
Practice Address - Fax:386-738-4865
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043411600Medicaid