Provider Demographics
NPI:1740283852
Name:DANIVAS, ANIL SA
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:SA
Last Name:DANIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 MALLARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:318-473-9558
Mailing Address - Fax:
Practice Address - Street 1:501 MEDICAL CENTER DRIVE BOX 30140
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-443-5439
Practice Address - Fax:318-487-9584
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11757R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1682152Medicaid
LAG31901Medicare UPIN