Healthcare Provider Details

I. General information

NPI: 1326230418
Provider Name (Legal Business Name): MANJARI SHRIKANT ANAGOL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3834 S WESTERN AVE
LOS ANGELES CA
90062-1104
US

IV. Provider business mailing address

3834 SOUTH WESTERN,
LOS ANGELES CA
90062
US

V. Phone/Fax

Practice location:
  • Phone: 323-730-3576
  • Fax:
Mailing address:
  • Phone: 323-730-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA38307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: