Provider Demographics
NPI:1962508630
Name:ANZALDO, EPIFANIO PETER (MD)
Entity Type:Individual
Prefix:
First Name:EPIFANIO
Middle Name:PETER
Last Name:ANZALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E
Other - Middle Name:PETER
Other - Last Name:ANZALDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1310 W STEWART DR STE 403
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3855
Mailing Address - Country:US
Mailing Address - Phone:714-997-7140
Mailing Address - Fax:714-997-0863
Practice Address - Street 1:1310 W STEWART DR STE 403
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3855
Practice Address - Country:US
Practice Address - Phone:714-997-7140
Practice Address - Fax:714-997-0863
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36638207V00000X, 207VG0400X, 207VX0000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46751Medicare UPIN