Healthcare Provider Details

I. General information

NPI: 1891911269
Provider Name (Legal Business Name): ANILA C. THAMPY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 E HERNDON AVE SUITE 102
FRESNO CA
93720-3359
US

IV. Provider business mailing address

1660 E HERNDON AVE SUITE 102
FRESNO CA
93720-3359
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-9024
  • Fax: 559-437-0431
Mailing address:
  • Phone: 559-437-9024
  • Fax: 559-437-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA48322
License Number StateCA

VIII. Authorized Official

Name: DR. ANILA THAMPY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 559-284-6264