Healthcare Provider Details

I. General information

NPI: 1255837597
Provider Name (Legal Business Name): ANIRUDH VIJAY CHANDRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GLADSTONE DR STE 3
PITTSBURG CA
94565-5123
US

IV. Provider business mailing address

2220 GLADSTONE DR STE 3
PITTSBURG CA
94565-5123
US

V. Phone/Fax

Practice location:
  • Phone: 925-432-3318
  • Fax: 925-432-0886
Mailing address:
  • Phone: 925-432-3318
  • Fax: 925-432-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number87906
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A19111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: