Healthcare Provider Details

I. General information

NPI: 1750597688
Provider Name (Legal Business Name): NEAL ANZAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY
BERKELEY CA
94704
US

IV. Provider business mailing address

2001 DWIGHT WAY STE 4190
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-5222
  • Fax:
Mailing address:
  • Phone: 510-204-5222
  • Fax: 510-204-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG50347
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6308
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6308
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG50347
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG50347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: