Provider Demographics
NPI:1912411885
Name:DR ANIL DATE MD
Entity Type:Organization
Organization Name:DR ANIL DATE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-365-6632
Mailing Address - Street 1:25050 AVENUE KEARNY STE 208
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1257
Mailing Address - Country:US
Mailing Address - Phone:661-430-0940
Mailing Address - Fax:
Practice Address - Street 1:11550 INDIAN HILLS RD STE 350
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1252
Practice Address - Country:US
Practice Address - Phone:818-365-6632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA125970OtherSTATE LICENSE