Provider Demographics
NPI:1932867462
Name:IMRAN, ANUSHA
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:IMRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 W HUNTINGTON DR STE 309
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3493
Mailing Address - Country:US
Mailing Address - Phone:626-445-8481
Mailing Address - Fax:
Practice Address - Street 1:289 W HUNTINGTON DR STE 309
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3493
Practice Address - Country:US
Practice Address - Phone:626-445-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant