Provider Demographics
NPI:1871627463
Name:EMIL A ANAYA MD, INC. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EMIL A ANAYA MD, INC. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-258-8760
Mailing Address - Street 1:PO BOX 3133
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95156-3133
Mailing Address - Country:US
Mailing Address - Phone:408-258-8760
Mailing Address - Fax:408-258-3645
Practice Address - Street 1:105 N BASCOM AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1811
Practice Address - Country:US
Practice Address - Phone:408-258-8760
Practice Address - Fax:408-258-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA258102086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811994445OtherINDIVIDUAL NPI
CAZZZ06033ZOtherGROUP PTAN
CAA25810OtherCALIFORNIA MEDICAL LICENS
CA00A258101Medicare PIN
A24579Medicare UPIN