Healthcare Provider Details

I. General information

NPI: 1962508630
Provider Name (Legal Business Name): EPIFANIO PETER ANZALDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: E PETER ANZALDO M.D.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 403
ORANGE CA
92868-3855
US

IV. Provider business mailing address

1310 W STEWART DR STE 403
ORANGE CA
92868-3855
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-7140
  • Fax: 714-997-0863
Mailing address:
  • Phone: 714-997-7140
  • Fax: 714-997-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG36638
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG36638
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG36638
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG36638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: