Provider Demographics
NPI:1972000537
Name:MLNARIK, ANASTASIA LEA (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:LEA
Last Name:MLNARIK
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 1:11943 EL CAMINO REAL STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2597
Mailing Address - Country:US
Mailing Address - Phone:858-793-1011
Mailing Address - Fax:
Practice Address - Street 1:11943 EL CAMINO REAL STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2597
Practice Address - Country:US
Practice Address - Phone:858-793-1011
Practice Address - Fax:858-793-1035
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics