Provider Demographics
NPI:1205869625
Name:PAKULA, ANITA SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:SUSAN
Last Name:PAKULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:52-121 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:805-494-6920
Mailing Address - Fax:805-494-6922
Practice Address - Street 1:1250 LA VENTA DR
Practice Address - Street 2:105
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3702
Practice Address - Country:US
Practice Address - Phone:805-494-6920
Practice Address - Fax:805-494-6922
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71177207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205869625OtherCCS PANELED PROVIDER
CA1205869625Medicaid
CAF43956Medicare UPIN
CABV270ZMedicare PIN
CAWG71177BMedicare PIN
CABV270YMedicare PIN