Provider Demographics
NPI:1700451804
Name:PEDDADA, ANITA NICOLE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:NICOLE
Last Name:PEDDADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:PEDDADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RADT I
Mailing Address - Street 1:11027 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2431
Mailing Address - Country:US
Mailing Address - Phone:818-985-8323
Mailing Address - Fax:
Practice Address - Street 1:11027 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2431
Practice Address - Country:US
Practice Address - Phone:818-985-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)