Provider Demographics
NPI:1912044181
Name:ANANDA, ANANDA P (MD,)
Entity Type:Individual
Prefix:DR
First Name:ANANDA
Middle Name:P
Last Name:ANANDA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S VENTURA RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-4905
Mailing Address - Country:US
Mailing Address - Phone:805-984-0144
Mailing Address - Fax:805-487-7445
Practice Address - Street 1:2800 S VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4905
Practice Address - Country:US
Practice Address - Phone:805-984-0144
Practice Address - Fax:805-487-7445
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A353010Medicaid
CAA27738Medicare UPIN
CAWA35301AMedicare ID - Type Unspecified