Healthcare Provider Details

I. General information

NPI: 1285687756
Provider Name (Legal Business Name): ANIL TIWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/07/2023
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 ALTON PARKWAY MOB 2
IRVINE CA
92618
US

IV. Provider business mailing address

PO BOX 406
CORONA DEL MAR CA
92625-0406
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-2284
  • Fax:
Mailing address:
  • Phone: 949-932-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA84690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: