Provider Demographics
NPI:1952336075
Name:ANITA M. PAI, M.D. INC
Entity Type:Organization
Organization Name:ANITA M. PAI, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-953-0409
Mailing Address - Street 1:1533 SERPENTINE DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6558
Mailing Address - Country:US
Mailing Address - Phone:909-953-0409
Mailing Address - Fax:
Practice Address - Street 1:6800 BROCKTON AVE
Practice Address - Street 2:STE 2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3810
Practice Address - Country:US
Practice Address - Phone:951-683-0650
Practice Address - Fax:915-774-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74144208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A741441Medicare PIN
CAI00438Medicare UPIN
CAZZZ02672ZMedicare PIN