Healthcare Provider Details

I. General information

NPI: 1871948133
Provider Name (Legal Business Name): MARIA ANASIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 04/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 E WHITE CHAPEL CT UNIT A
ORANGE CA
92869-7518
US

IV. Provider business mailing address

3432 E WHITE CHAPEL CT UNIT A
ORANGE CA
92869-7518
US

V. Phone/Fax

Practice location:
  • Phone: 714-904-5732
  • Fax:
Mailing address:
  • Phone: 714-904-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95001923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: