Provider Demographics
NPI:1982658761
Name:GUANCHE, ANNA D (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:D
Last Name:GUANCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:23622 CALABASAS RD
Mailing Address - Street 2:SUITE 339
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1549
Mailing Address - Country:US
Mailing Address - Phone:818-225-0117
Mailing Address - Fax:818-225-0127
Practice Address - Street 1:23622 CALABASAS RD
Practice Address - Street 2:SUITE 339
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1549
Practice Address - Country:US
Practice Address - Phone:818-225-0117
Practice Address - Fax:818-225-0127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA85096207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH80985Medicare UPIN