Healthcare Provider Details

I. General information

NPI: 1104907377
Provider Name (Legal Business Name): ANITA RICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANITA SRIVASTAVA M.D.

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SPENCER WAY
LOS ALTOS CA
94024-4927
US

IV. Provider business mailing address

629A E HILLSBORO BLVD
DEERFIELD BEACH FL
33441-3517
US

V. Phone/Fax

Practice location:
  • Phone: 650-963-9222
  • Fax:
Mailing address:
  • Phone: 954-698-9399
  • Fax: 954-698-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA74032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME98042
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: