Healthcare Provider Details

I. General information

NPI: 1548267842
Provider Name (Legal Business Name): ANNE VANGARSSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E YOSEMITE AVE
MADERA CA
93638-3604
US

IV. Provider business mailing address

2500 ALLUVIAL AVE
CLOVIS CA
93611-9544
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax:
Mailing address:
  • Phone: 785-766-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0429532
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC158818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: