Healthcare Provider Details

I. General information

NPI: 1588528301
Provider Name (Legal Business Name): STANLEY B ANJAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 STANFORD AVE
LOS ANGELES CA
90021-1847
US

IV. Provider business mailing address

255 W 5TH ST APT 205
SAN PEDRO CA
90731-3390
US

V. Phone/Fax

Practice location:
  • Phone: 714-833-4435
  • Fax:
Mailing address:
  • Phone: 714-833-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: