Provider Demographics
NPI:1457431439
Name:ANAYA, CARLOS R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:ANAYA
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 1:3100 W CHARLESTON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1992
Mailing Address - Country:US
Mailing Address - Phone:702-320-7930
Mailing Address - Fax:702-320-7932
Practice Address - Street 1:3100 W CHARLESTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1992
Practice Address - Country:US
Practice Address - Phone:702-320-7930
Practice Address - Fax:702-320-7932
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018441Medicaid
G31875Medicare UPIN
34476Medicare ID - Type Unspecified