Provider Demographics
NPI:1821033309
Name:HARTE, ANNA YLVA BLOXHAM (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:YLVA BLOXHAM
Last Name:HARTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:YLVA
Other - Last Name:BLOXHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2222 BANCROFT WAY
Mailing Address - Street 2:#4300
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4300
Mailing Address - Country:US
Mailing Address - Phone:510-643-7110
Mailing Address - Fax:510-643-2997
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:#4300
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-643-7110
Practice Address - Fax:510-643-2997
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A721260Medicaid
CA00A721260Medicare PIN
CAH50701Medicare UPIN