MEDICARE: DR. ANNA STARK PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY26387	CA

General Provider Information

NPI Number	:	1922137769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA STARK PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 18631
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95158-8631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 S WHITE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-3812
Country	:	US
Telephone Number	:	408-729-9700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	12/23/2021

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