Healthcare Provider Details

I. General information

NPI: 1184855546
Provider Name (Legal Business Name): ANJALI LARA SARDESHMUKH L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 SUMMIT ST STE 303
OAKLAND CA
94609-3404
US

IV. Provider business mailing address

2939 SUMMIT ST STE 303
OAKLAND CA
94609-3404
US

V. Phone/Fax

Practice location:
  • Phone: 510-740-8490
  • Fax:
Mailing address:
  • Phone: 510-740-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 228
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number513
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-315717
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: