Healthcare Provider Details

I. General information

NPI: 1962714618
Provider Name (Legal Business Name): ANISH RANJAN DUBE M.D., M.P.H, M.L.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18818 US HIGHWAY 18
APPLE VALLEY CA
92307-2323
US

IV. Provider business mailing address

1731 E 120TH ST
LOS ANGELES CA
90059-3051
US

V. Phone/Fax

Practice location:
  • Phone: 909-386-9758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA134541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA134541
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA134541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: