Provider Demographics
NPI:1780085779
Name:BERENSHTEYN, ANYA (NP)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:BERENSHTEYN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BERENSHTEYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:751 E DAILY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6076
Mailing Address - Country:US
Mailing Address - Phone:805-256-7810
Mailing Address - Fax:805-256-7840
Practice Address - Street 1:751 E DAILY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6076
Practice Address - Country:US
Practice Address - Phone:805-256-7810
Practice Address - Fax:805-256-7840
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001153363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95001153OtherNURSE PRACTITIONER LICENSE