Healthcare Provider Details

I. General information

NPI: 1720643729
Provider Name (Legal Business Name): ANH DO REBHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD STE 210
COSTA MESA CA
92627-3786
US

IV. Provider business mailing address

1640 NEWPORT BLVD STE 210
COSTA MESA CA
92627-3786
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-7332
  • Fax:
Mailing address:
  • Phone: 496-427-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: